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Cognigni V, Giudice GC, Bozzetti F, Milanese G, Moschini I, Casali M, Mazzaschi G, Tiseo M. Successful treatment with selpercatinib after pralsetinib-related pneumonitis and intracranial failure in a patient with RET-rearranged nonsmall cell lung cancer. Anticancer Drugs 2024; 35:559-562. [PMID: 38453158 PMCID: PMC11078287 DOI: 10.1097/cad.0000000000001590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 02/03/2024] [Indexed: 03/09/2024]
Abstract
Pralsetinib and selpercatinib are two highly potent and selective rearranged during transfection (RET) inhibitors that substantially improved the clinical outcome of patients with RET-rearranged non-small cell lung cancer. Treatment with one RET inhibitor after failure of the other is generally not recommended because of cross-resistance mechanisms. We report the case of a patient affected by metastatic RET-rearranged non-small cell lung cancer who experienced long-lasting disease control with pralsetinib. After 13 months from treatment start, the patient developed recurrent drug-related pneumonitis, requiring temporary interruptions and dose reductions and eventually failing to control the disease. Selpercatinib was then started as an off-label treatment, allowing both clinical and radiological intracranial disease control. Selpercatinib was well-tolerated at full dosage, and no pulmonary event occurred. In our case report, after pralsetinib dose reduction due to pulmonary toxicity, the therapeutic switch to selpercatinib allowed the patient to receive a full-dose treatment, eventually restoring disease control. Our case report and a few literature data suggest that switching from pralsetinib to selpercatinib may represent a therapeutic opportunity, especially for patients with brain metastases.
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Affiliation(s)
- Valeria Cognigni
- Department of Medical Oncology, Università Politecnica delle Marche, Ancona
| | | | - Francesca Bozzetti
- Department of Medicine and Surgery, University of Parma
- Neuroradiology Unit
| | - Gianluca Milanese
- Department of Medicine and Surgery, University of Parma
- Radiology Unit, University Hospital of Parma, Parma
| | | | - Miriam Casali
- Medical Oncology Unit, Azienda Socio-Sanitaria Territoriale di Lodi, Lodi, Italy
| | - Giulia Mazzaschi
- Department of Medicine and Surgery, University of Parma
- Medical Oncology Unit
| | - Marcello Tiseo
- Department of Medicine and Surgery, University of Parma
- Medical Oncology Unit
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Jain AG, Gesiotto Q, Ball S, Nodzon L, Rodriguez A, Chan O, Padron E, Kuykendall A, Komrokji R, Sallman DA, Lancet JE, Pinilla-Ibarz J, Sweet K. Incidence of pleural effusion with dasatinib and the effect of switching therapy to a different TKI in patients with chronic phase CML. Ann Hematol 2024; 103:1941-1945. [PMID: 38634915 DOI: 10.1007/s00277-024-05760-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/12/2024] [Indexed: 04/19/2024]
Abstract
Dasatinib is one of the second generation tyrosine kinase inhibitors (TKI) which is approved for the treatment of patients with chronic phase CML (CP-CML) both in the front line and in the second line setting. Pleural effusion (PE) is a unique toxicity associated with dasatinib use. Our aim was to study the incidence of pleural effusion in our cohort of patients who were treated with dasatinib for CP-CML and the safety upon TKI switch. A total of 390 patients were treated with dasatinib during their course of treatment for CP-CML. A total of 69 patients (17.6%) developed any grade of PE. About 33 (48%) patients developed CTCAE grade 2 PE, 34 (49%) grade 3 and only 1 patient developed grade 4 PE. Recurrence of PE was observed in 34 (49%) patients. While only 12 patients (17.3%) continued using dasatinib after development of PE, dasatinib was discontinued in the other 57 patients. Therapy was switched to bosutinib in 13 patients out of which 6 (46%) patients re-developed PE. While only 12.5% patients developed re-accumulation of pleural fluid in patients switched to imatinib, none of the patients switched to nilotinib re-developed PE. A change in TKI to bosutinib was associated with a 46% risk of recurrence of PE in patients who develop PE on dasatinib for the treatment of CP-CML. The incidence of recurrent PE was markedly lower in patient switched to imatinib or nilotinib.
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Affiliation(s)
- Akriti G Jain
- Taussig Cancer Institute, Cleveland Clinic, 9500 Euclid Avenue CA-60,, Cleveland, OH, 44195, USA.
| | - Quinto Gesiotto
- Hematology Oncology Fellow, Thomas Jefferson University, Philadelphia, PA, USA
| | - Somedeb Ball
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lisa Nodzon
- Division of Malignant Hematology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Amanda Rodriguez
- Division of Malignant Hematology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Onyee Chan
- Division of Malignant Hematology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Eric Padron
- Division of Malignant Hematology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Andrew Kuykendall
- Division of Malignant Hematology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Rami Komrokji
- Division of Malignant Hematology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - David A Sallman
- Division of Malignant Hematology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Jeffrey E Lancet
- Division of Malignant Hematology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Javier Pinilla-Ibarz
- Division of Malignant Hematology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Kendra Sweet
- Division of Malignant Hematology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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Mutch D, Voulgari A, Chen XM, Bradley WH, Oaknin A, Perez Fidalgo JA, Montosa FG, Herraez AC, Holloway RW, Powell MA, Nowicka M, Schaefer G, Merchant M, Yan Y. Primary results and characterization of patients with exceptional outcomes in a phase 1b study combining PARP and MEK inhibition, with or without anti-PD-L1, for BRCA wild-type, platinum-sensitive, recurrent ovarian cancer. Cancer 2024; 130:1940-1951. [PMID: 38288862 DOI: 10.1002/cncr.35222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/21/2023] [Accepted: 01/03/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND This phase 1b study (ClinicalTrials.gov identifier NCT03695380) evaluated regimens combining PARP and MEK inhibition, with or without PD-L1 inhibition, for BRCA wild-type, platinum-sensitive, recurrent ovarian cancer (PSROC). METHODS Patients with PSROC who had received one or two prior treatment lines were treated with 28-day cycles of cobimetinib 60 mg daily (days 1-21) plus niraparib 200 mg daily (days 1-28) with or without atezolizumab 840 mg (days 1 and 15). Stage 1 assessed safety before expansion to stage 2, which randomized patients who had BRCA wild-type PSROC to receive either doublet or triplet therapy, stratified by genome-wide loss of heterozygosity status (<16% vs. ≥16%; FoundationOne CDx assay) and platinum-free interval (≥6 to <12 vs. ≥12 months). Coprimary end points were safety and the investigator-determined objective response rate (ORR) according to Response Evaluation Criteria in Solid Tumors (RECIST). Potential associations between genetic parameters and efficacy were explored, and biomarker profiles of super-responders (complete response or those with progression-free survival [PFS] >15 months) and progressors (disease progression as the best response) were characterized. RESULTS The ORR in patients who had BRCA wild-type PSROC was 35% (95% confidence interval, 20%-53%) with the doublet regimen (n = 37) and 27% (95% confidence interval, 14%-44%) with the triplet regimen (n = 37), and the median PFS was 6.0 and 7.4 months, respectively. Post-hoc analyses indicated more favorable ORR and PFS in the homologous recombination-deficiency-signature (HRDsig)-positive subgroup than in the HRDsig-negative subgroup. Tolerability was consistent with the known profiles of individual agents. NF1 and MKNK1 mutations were associated with sustained benefit from the doublet and triplet regimens, respectively. CONCLUSIONS Chemotherapy-free doublet and triplet therapy demonstrated encouraging activity, including among patients who had BRCA wild-type, HRDsig-positive or HRDsig-negative PSROC harboring NF1 or MKNK1 mutations.
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Affiliation(s)
- David Mutch
- Division of Gynecology Oncology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Athina Voulgari
- Global Product Development Clinical Science, Roche Products Ltd., Welwyn Garden City, UK
| | - Xian Marissa Chen
- Translational Medicine, Genentech, Inc., South San Francisco, California, USA
| | - William H Bradley
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Ana Oaknin
- Medical Oncology Service, Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - José Alejandro Perez Fidalgo
- Hospital Clínico Universitario Valencia, Biomedical Research Institute INCLIVA, Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Valencia, Spain
| | | | - Antonio Casado Herraez
- Department of Medical Oncology, Hospital Universitario San Carlos, Universidad Complutense, IdISSC, Madrid, Spain
| | - Robert W Holloway
- Gynecologic Oncology, AdventHealth Cancer Institute, Orlando, Florida, USA
| | - Matthew A Powell
- Division of Gynecology Oncology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Malgorzata Nowicka
- Translational Medicine, Genentech, Inc., South San Francisco, California, USA
| | - Gabriele Schaefer
- Molecular Oncology, Genentech, Inc., South San Francisco, California, USA
| | - Mark Merchant
- Translational Oncology, Genentech, Inc., South San Francisco, California, USA
| | - Yibing Yan
- Translational Medicine, Genentech, Inc., South San Francisco, California, USA
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Li W, Chang Y, Liu X, Chen Z, Sun J, Geng Z, Zhang M, Zhang L. Modified R-BAC plus BTK inhibitor regimen in newly diagnosed young patients with mantle cell lymphoma: a real-world retrospective study. Ann Hematol 2024; 103:2003-2012. [PMID: 38308020 DOI: 10.1007/s00277-024-05648-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/28/2024] [Indexed: 02/04/2024]
Abstract
To explore the optimal treatment for young patients with untreated mantle cell lymphoma (MCL), we compared the efficacy and safety of R-CHOP/R-DHAP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone/rituximab, dexamethasone, cytarabine and cisplatin) and R-BAP (rituximab, bendamustine, cytarabine, and prednisone) plus BTK (Bruton's tyrosine kinase) inhibitors in newly diagnosed patients. Eighty-three young patients (≤ 65 years old) with newly diagnosed MCL admitted to the First Affiliated Hospital of Zhengzhou University from January 1, 2014, to June 1, 2023, using R-CHOP/R-DHAP or R-BAP plus BTK inhibitor were assessed in this study. The median age at presentation was 60 (42-65) years in 83 patients, including 64 males and 19 females; 59 were treated with R-CHOP/R-DHAP regimen chemotherapy, and 24 were treated with R-BAP in combination with the BTK inhibitor regimen. The median follow-up was 17 months (2-86 months) in 83 patients, and the median PFS (progression-free survival) time was not reached. The CRR (complete response rate) of the R-BAP group was higher than that of the R-CHOP/R-DHAP group (87.5% vs. 54.2%, P = 0.005). The ORR (overall response rate) was not significantly different between the two groups (ORR: 91.7% vs. 84.7%, P = 0.497). The PFS (progression-free survival) of the R-BAP group was longer than that of the R-CHOP/R-DHAP group (P = 0.013), whereas OS was not significantly different between the two groups (P = 0.499). The most common adverse effect in both groups was hematotoxicity, with a higher incidence of grade 3-4 lymphopenia and grade 3-4 thrombocytopenia in the R-BAP group than in the R-CHOP/R-DHAP group (P = 0.015 and P = 0.039). Male sex (HR = 4.257, P = 0.013), LDH (lactate dehydrogenase) ≥ 245 U/L (HR = 3.221, P = 0.012), pleomorphic-blastoid (HR = 2.802, P = 0.043) and R-CHOP/R-DHAP regimen (HR = 7.704, P = 0.047) were independent risk factors for PFS. Ki67 ≥ 30% (HR = 8.539, P = 0.005) was an independent risk factor for OS. First-line treatment with R-BAP in combination with BTK inhibitor improved CRR and prolonged PFS in young patients with mantle cell lymphoma and adverse events were tolerable.
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Affiliation(s)
- Wenqi Li
- Affiliation Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
| | - Yu Chang
- Affiliation Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, 450000, China
| | - Xiyang Liu
- Affiliation Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, 450000, China
| | - Ziqi Chen
- Affiliation Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
| | - Jinmiao Sun
- Affiliation Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
| | - Zurui Geng
- Affiliation Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
| | - Mingzhi Zhang
- Affiliation Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, 450000, China
| | - Lei Zhang
- Affiliation Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China.
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, 450000, China.
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Eugster R, Ganguin AA, Seidi A, Aleandri S, Luciani P. 3D printing injectable microbeads using a composite liposomal ink for local treatment of peritoneal diseases. Drug Deliv Transl Res 2024; 14:1567-1581. [PMID: 38006449 PMCID: PMC11052830 DOI: 10.1007/s13346-023-01472-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2023] [Indexed: 11/27/2023]
Abstract
The peritoneal cavity offers an attractive administration route for challenging-to-treat diseases, such as peritoneal carcinomatosis, post-surgical adhesions, and peritoneal fibrosis. Achieving a uniform and prolonged drug distribution throughout the entire peritoneal space, though, is difficult due to high clearance rates, among others. To address such an unmet clinical need, alternative drug delivery approaches providing sustained drug release, reduced clearance rates, and a patient-centric strategy are required. Here, we describe the development of a 3D-printed composite platform for the sustained release of the tyrosine kinase inhibitor gefitinib (GEF), a small molecule drug with therapeutic applications for peritoneal metastasis and post-surgical adhesions. We present a robust method for the production of biodegradable liposome-loaded hydrogel microbeads that can overcome the pharmacokinetic limitations of small molecules with fast clearance rates, a current bottleneck for the intraperitoneal (IP) administration of these therapeutics. By means of an electromagnetic droplet printhead, we 3D printed microbeads employing an alginate-based ink loaded with GEF-containing multilamellar vesicles (MLVs). The sustained release of GEF from microbeads was demonstrated. In vitro studies on an immortalized human hepatic cancer cell line (Huh-7) proved concentration-dependent cell death. These findings demonstrate the potential of 3D-printed alginate microbeads containing liposomes for delivering small drug compounds into the peritoneum, overcoming previous limitations of IP drug delivery.
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Affiliation(s)
- Remo Eugster
- Department of Chemistry, Biochemistry and Pharmaceutical Sciences, University of Bern, Freiestrasse 3, CH-3012, Bern, Switzerland
| | - Aymar Abel Ganguin
- Department of Chemistry, Biochemistry and Pharmaceutical Sciences, University of Bern, Freiestrasse 3, CH-3012, Bern, Switzerland
| | - Amirmohammad Seidi
- Department of Chemistry, Biochemistry and Pharmaceutical Sciences, University of Bern, Freiestrasse 3, CH-3012, Bern, Switzerland
| | - Simone Aleandri
- Department of Chemistry, Biochemistry and Pharmaceutical Sciences, University of Bern, Freiestrasse 3, CH-3012, Bern, Switzerland
| | - Paola Luciani
- Department of Chemistry, Biochemistry and Pharmaceutical Sciences, University of Bern, Freiestrasse 3, CH-3012, Bern, Switzerland.
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Algazi AP, Moon J, Lao CD, Chmielowski B, Kendra KL, Lewis KD, Gonzalez R, Kim K, Godwin JE, Curti BD, Latkovic-Taber M, Lomeli SH, Gufford BT, Scumpia PO, Lo RS, Othus M, Ribas A. A phase 1 study of triple-targeted therapy with BRAF, MEK, and AKT inhibitors for patients with BRAF-mutated cancers. Cancer 2024; 130:1784-1796. [PMID: 38261444 DOI: 10.1002/cncr.35200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/30/2023] [Accepted: 11/21/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Aberrant PI3K/AKT signaling in BRAF-mutant cancers contributes to resistance to BRAF inhibitors. The authors examined dual MAPK and PI3K pathway inhibition in patients who had BRAF-mutated solid tumors (ClinicalTrials.gov identifier NCT01902173). METHODS Patients with BRAF V600E/V600K-mutant solid tumors received oral dabrafenib at 150 mg twice daily with dose escalation of oral uprosertib starting at 50 mg daily, or, in the triplet cohorts, with dose escalation of both oral trametinib starting at 1.5 mg daily and oral uprosertib starting at 25 mg daily. Dose-limiting toxicities (DLTs) were assessed within the first 56 days of treatment. Radiographic responses were assessed at 8-week intervals. RESULTS Twenty-seven patients (22 evaluable) were enrolled in parallel doublet and triplet cohorts. No DLTs were observed in the doublet cohorts (N = 7). One patient had a DLT at the maximum administered dose of triplet therapy (dabrafenib 150 mg twice daily and trametinib 2 mg daily plus uprosertib 75 mg daily). Three patients in the doublet cohorts had partial responses (including one who had BRAF inhibitor-resistant melanoma). Two patients in the triplet cohorts had a partial response, and one patient had an unconfirmed partial response. Pharmacokinetic data suggested reduced dabrafenib and dabrafenib metabolite exposure in patients who were also exposed to both trametinib and uprosertib, but not in whose who were exposed to uprosertib without trametinib. CONCLUSIONS Concomitant inhibition of both the MAPK and PI3K-AKT pathways for the treatment of BRAF-mutated cancers was well tolerated, leading to objective responses, but higher level drug-drug interactions affected exposure to dabrafenib and its metabolites.
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Affiliation(s)
- Alain P Algazi
- University of California-San Francisco, San Francisco, California, USA
| | - James Moon
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Southwest Oncology Group Statistical Center, Seattle, Washington, USA
| | | | - Bartosz Chmielowski
- Jonsson Comprehensive Cancer Center, University of California-Los Angeles, Los Angeles, California, USA
| | - Kari L Kendra
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Karl D Lewis
- University of Colorado Comprehensive Cancer Center, Denver, Colorado, USA
| | - Rene Gonzalez
- University of Colorado Comprehensive Cancer Center, Denver, Colorado, USA
| | - Kevin Kim
- California Pacific Medical Center Research Institute, San Francisco, California, USA
| | | | | | | | - Shirley H Lomeli
- Jonsson Comprehensive Cancer Center, University of California-Los Angeles, Los Angeles, California, USA
| | | | - Philip O Scumpia
- Jonsson Comprehensive Cancer Center, University of California-Los Angeles, Los Angeles, California, USA
| | - Roger S Lo
- Jonsson Comprehensive Cancer Center, University of California-Los Angeles, Los Angeles, California, USA
| | - Megan Othus
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Antoni Ribas
- Jonsson Comprehensive Cancer Center, University of California-Los Angeles, Los Angeles, California, USA
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Yap TA, Tolcher AW, Plummer R, Mukker JK, Enderlin M, Hicking C, Grombacher T, Locatelli G, Szucs Z, Gounaris I, de Bono JS. First-in-Human Study of the Ataxia Telangiectasia and Rad3-Related (ATR) Inhibitor Tuvusertib (M1774) as Monotherapy in Patients with Solid Tumors. Clin Cancer Res 2024; 30:2057-2067. [PMID: 38407317 PMCID: PMC11094421 DOI: 10.1158/1078-0432.ccr-23-2409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/26/2023] [Accepted: 02/21/2024] [Indexed: 02/27/2024]
Abstract
PURPOSE Tuvusertib (M1774) is a potent, selective, orally administered ataxia telangiectasia and Rad3-related (ATR) protein kinase inhibitor. This first-in-human study (NCT04170153) evaluated safety, tolerability, maximum tolerated dose (MTD), recommended dose for expansion (RDE), pharmacokinetics (PK), pharmacodynamics (PD), and preliminary efficacy of tuvusertib monotherapy. PATIENTS AND METHODS Ascending tuvusertib doses were evaluated in 55 patients with metastatic or locally advanced unresectable solid tumors. A safety monitoring committee determined dose escalation based on PK, PD, and safety data guided by a Bayesian 2-parameter logistic regression model. Molecular responses (MR) were assessed in circulating tumor DNA samples. RESULTS Most common grade ≥3 treatment-emergent adverse events were anemia (36%), neutropenia, and lymphopenia (both 7%). Eleven patients experienced dose-limiting toxicities, most commonly grade 2 (n = 2) or 3 (n = 8) anemia. No persistent effects on blood immune cell populations were observed. The RDE was 180 mg tuvusertib QD (once daily), 2 weeks on/1 week off treatment, which was better tolerated than the MTD (180 mg QD continuously). Tuvusertib median time to peak plasma concentration ranged from 0.5 to 3.5 hours and mean elimination half-life from 1.2 to 5.6 hours. Exposure-related PD analysis suggested maximum target engagement at ≥130 mg tuvusertib QD. Tuvusertib induced frequent MRs in the predicted efficacious dose range; MRs were enriched in patients with radiological disease stabilization, and complete MRs were detected for mutations in ARID1A, ATRX, and DAXX. One patient with platinum- and PARP inhibitor-resistant BRCA wild-type ovarian cancer achieved an unconfirmed RECIST v1.1 partial response. CONCLUSIONS Tuvusertib demonstrated manageable safety and exposure-related target engagement. Further clinical evaluation of tuvusertib is ongoing.
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Affiliation(s)
- Timothy A. Yap
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Ruth Plummer
- Newcastle University and Northern Centre for Cancer Care, Newcastle Hospitals NHS Trust, Newcastle Upon Tyne, United Kingdom
| | | | - Marta Enderlin
- The Healthcare Business of Merck KGaA, Darmstadt, Germany
| | | | | | | | - Zoltan Szucs
- Merck Serono Ltd., Feltham, UK, an affiliate of Merck KGaA, Darmstadt, Germany
| | - Ioannis Gounaris
- Merck Serono Ltd., Feltham, UK, an affiliate of Merck KGaA, Darmstadt, Germany
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Xiao Y, Deng W, Luo L, Zhu G, Xie J, Liu Y, Wan R, Wen W, Hu Z, Shan R. Beneficial effects of maintaining liver function during hepatic arterial infusion chemotherapy combined with tyrosine kinase and programmed cell death protein-1 inhibitors on the outcomes of patients with unresectable hepatocellular carcinoma. BMC Cancer 2024; 24:588. [PMID: 38745113 PMCID: PMC11092091 DOI: 10.1186/s12885-024-12355-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 05/07/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND AND AIM Combination therapy is the primary treatment for unresectable hepatocellular carcinoma (u-HCC). The hepatic functional reserve is also critical in the treatment of HCC. In this study, u-HCC was treated with combined hepatic arterial infusion chemotherapy (HAIC), tyrosine kinase inhibitors (TKIs), and programmed cell death protein-1 (PD-1) inhibitors to analyze the therapeutic response, progression-free survival (PFS), and safety. METHODS One hundred sixty-two (162) patients with u-HCC were treated by combination therapy of HAIC, TKIs, and PD-1 inhibitors. PFS was assessed by Child-Pugh (CP) classification subgroups and the change in the CP score during treatment. RESULTS The median PFS was 11.7 and 5.1 months for patients with CP class A (CPA) and CP class B (CPB), respectively (p = 0.013), with respective objective response rates of 61.1 and 27.8% (p = 0.002) and conversion rates of 16 and 0% (p = 0.078). During treatment, the CP scores in patients with CPA worsened less in those with complete and partial response than in those with stable and progressive disease. In the CP score 5, patients with an unchanged CP score had longer PFS than those with a worsened score (Not reached vs. 7.9 months, p = 0.018). CPB was an independent factor negatively affecting treatment response and PFS. Patients with CPA responded better to the combination therapy and had fewer adverse events (AEs) than those with CPB. CONCLUSIONS Thus, triple therapy is more beneficial in patients with good liver function, and it is crucial to maintain liver function during treatment.
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Affiliation(s)
- Yongqiang Xiao
- Department of General Surgery, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, No. 17, Yongwaizheng Street, Nanchang, 330006, Jiangxi, China
- Department of General Surgery, Ganjiang New Area People's Hospital, Nanchang, Jiangxi, China
- Department of General Surgery, Ganjiang New Area Hospital of the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Wei Deng
- Department of General Surgery, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, No. 17, Yongwaizheng Street, Nanchang, 330006, Jiangxi, China
| | - Laihui Luo
- Department of General Surgery, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, No. 17, Yongwaizheng Street, Nanchang, 330006, Jiangxi, China
| | - Guoqing Zhu
- Department of General Surgery, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, No. 17, Yongwaizheng Street, Nanchang, 330006, Jiangxi, China
| | - Jin Xie
- Department of General Surgery, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, No. 17, Yongwaizheng Street, Nanchang, 330006, Jiangxi, China
| | - Yu Liu
- Department of General Surgery, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, No. 17, Yongwaizheng Street, Nanchang, 330006, Jiangxi, China
| | - Renhua Wan
- Department of General Surgery, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, No. 17, Yongwaizheng Street, Nanchang, 330006, Jiangxi, China
| | - Wu Wen
- Department of General Surgery, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, No. 17, Yongwaizheng Street, Nanchang, 330006, Jiangxi, China
| | - Zhigao Hu
- Department of General Surgery, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, No. 17, Yongwaizheng Street, Nanchang, 330006, Jiangxi, China.
| | - Renfeng Shan
- Department of General Surgery, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, No. 17, Yongwaizheng Street, Nanchang, 330006, Jiangxi, China.
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Zeng L, Song L, Liu L, Wu F, Xu Q, Yan H, Lin S, Jiang W, Wang Z, Deng L, Qin H, Zhang X, Xiao J, Liu M, Liu Z, Zhang L, Zhou C, Xiong Y, Wang Y, Zhang Y, Yang N. First-in-human phase I study of BEBT-109 in previously treated EGFR exon 20 insertion-mutated advanced non-small cell lung cancer. Med 2024; 5:445-458.e3. [PMID: 38521070 DOI: 10.1016/j.medj.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 11/14/2023] [Accepted: 02/27/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND BEBT-109 is an oral pan-mutant-selective inhibitor of epidermal growth factor receptor (EGFR) that demonstrated promising antitumor potency in preclinical models. METHODS This first-in-human study was a single-arm, open-label, two-stage study. Phase Ia dose-escalation study evaluated the safety and pharmacokinetics of BEBT-109 in 11 patients with EGFR T790M-mutated advanced non-small cell lung cancer (aNSCLC). Phase Ib dose-expansion study evaluated the safety and efficacy of BEBT-109 in 18 patients with EGFR exon 20 insertion (ex20ins)-mutated treatment-refractory aNSCLC. The primary outcomes were adverse events and antitumor activity. Clinical trial registration number CTR20192575. FINDINGS The phase Ia study demonstrated no dose-limiting toxicity, no observation of the maximum tolerated dose, and no new safety signals with BEBT-109 in the dose range of 20-180 mg/d, suggesting that BEBT-109 had an acceptable safety profile among patients with EGFR T790M-mutated aNSCLC. Plasma pharmacokinetics of BEBT-109 showed a dose-proportional increase in the area under the curve and maximal concentration, with no significant drug accumulation. The dose-expansion study demonstrated that BEBT-109 treatment was tolerable across the three dose levels. The three most common treatment-related adverse events were diarrhea (100%; 22.2% ≥Grade 3), rash (66.7%; 5.6% ≥Grade 3), and anemia (61.1%; 0% ≥Grade 3). The objective response rate was 44.4% (8 of 18). Median progression-free survival was 8.0 months (95% confidence intervals, 1.33-14.67). CONCLUSION Preliminary findings showed that BEBT-109 had an acceptable safety profile and favorable antitumor activity in patients with refractory EGFR ex20ins-mutated aNSCLC. FUNDING National Natural Science Foundation of China.
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Affiliation(s)
- Liang Zeng
- Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, China; Graduate Collaborative Training Base of Hunan Cancer Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
| | - Lianxi Song
- Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, China; Graduate Collaborative Training Base of Hunan Cancer Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
| | - Li Liu
- Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, China
| | - Fang Wu
- Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, China
| | - Qinqin Xu
- Department of Medical Oncology, Qinghai Provincial People's Hospital, Xining 810000, China
| | - Huan Yan
- Department of Pathology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 20025, China
| | - Shaoding Lin
- Department of Medical Oncology, The First Affiliated Hospital of Hunan University of Medicine, Huaihua 418000, China
| | - Wenjuan Jiang
- Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, China
| | - Zhan Wang
- Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, China
| | - Li Deng
- Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, China
| | - Haoyue Qin
- Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, China; Graduate Collaborative Training Base of Hunan Cancer Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
| | - Xing Zhang
- Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, China; Graduate Collaborative Training Base of Hunan Cancer Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
| | - Jiwen Xiao
- Department of Medical Oncology, The First Affiliated Hospital of Huaihua, Huaihua 418000, China
| | - Min Liu
- Department of Medical Oncology, The Central Hospital of Zhuzhou, Zhuzhou 418012, China
| | - Zhaoyi Liu
- Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, China
| | - Lin Zhang
- Department of Radiology, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, China
| | - Chunhua Zhou
- Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, China
| | - Yi Xiong
- Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, China
| | - Ya Wang
- Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, China
| | - Yongchang Zhang
- Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, China; Graduate Collaborative Training Base of Hunan Cancer Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China.
| | - Nong Yang
- Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, China; Graduate Collaborative Training Base of Hunan Cancer Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China.
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10
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Nasrazadani A, Marti JLG, Lathrop K, Restrepo A, Leu SY, Bhat G, Brufsky A. Poziotinib treatment in patients with HER2-positive advanced breast cancer who have received prior anti-HER2 regimens. Breast Cancer Res Treat 2024; 205:29-37. [PMID: 38261228 DOI: 10.1007/s10549-023-07236-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 11/22/2023] [Indexed: 01/24/2024]
Abstract
PURPOSE Poziotinib is an irreversible pan-inhibitor of the human epidermal growth factor receptor (HER) that has shown acceptable tolerability and antitumor activity in phase I and II trials in patients with advanced solid tumors. In the present open-label, multicenter phase II study, we demonstrate safety, tolerability, and preliminary efficacy data from two different dosing schedules in patients with HER2-positive advanced breast cancer. PATIENTS AND METHODS Patients who had received at least two prior HER2-directed therapy lines for advanced disease, received 24 mg poziotinib on an intermittent dosing schedule (cohort 1) or 16 mg poziotinib once daily on a continuous dosing schedule (cohort 2). The primary endpoint was overall response rate (ORR). Secondary endpoints were progression-free survival (PFS), disease control rate (DCR), and time to progression (TTP). Secondary endpoints additionally included safety and pharmacokinetics. RESULTS A total of 67 patients were enrolled. The ORR was 30% in both groups (p = 0.98). DCR was 60% vs 78% (p = 0.15) and median PFS and TTP were 4.1 vs 4.9 months (both p = 0.30) for cohorts 1 and 2, respectively. The most common treatment related adverse events (AEs) of any grade included diarrhea (88% vs 85%, p = 0.76), rash (88% vs 88%, p = 0.96), and stomatitis (64% vs 56%, p = 0.52), with grade 3-4 diarrhea occurring in 33% vs 32% of patients (p = 0.93) and grade 3-4 rash in 27% vs 35% of patients (p = 0.48) in cohort 1 vs cohort 2, respectively. CONCLUSION Poziotinib demonstrated evidence of clinical activity in patients with pre-treated HER2-positive advanced breast cancer, although high levels of toxicity may preclude further studies at this time.
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Affiliation(s)
- Azadeh Nasrazadani
- Division of Breast Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | | | - Kate Lathrop
- The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | | | | | - Adam Brufsky
- Magee-Womens Hospital of UPMC, 300 Halket St, Pittsbugh, PA, 15213, USA.
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11
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Wang S, Chen X, Bai J, Sun Q, Fang H, Qiao J. Tofacitinib Treatment for Pretibial Myxedema. JAMA Dermatol 2024; 160:578-580. [PMID: 38568614 DOI: 10.1001/jamadermatol.2024.0344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
This case report describes tofacitinib treatment for 2 patients with pretibial myxedema.
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Affiliation(s)
- Su Wang
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xinyi Chen
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Juan Bai
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qingmiao Sun
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hong Fang
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jianjun Qiao
- Department of Dermatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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12
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Campbell MT, Balderrama-Brondani V, Jimenez C, Tamsen G, Marcal LP, Varghese J, Shah AY, Long JP, Zhang M, Ochieng J, Haymaker C, Habra MA. Cabozantinib monotherapy for advanced adrenocortical carcinoma: a single-arm, phase 2 trial. Lancet Oncol 2024; 25:649-657. [PMID: 38608694 DOI: 10.1016/s1470-2045(24)00095-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/07/2024] [Accepted: 02/12/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Adrenocortical carcinoma is a rare malignancy with poor response to systemic chemotherapy. Mitotane is the only approved therapy for adrenocortical carcinoma. Cabozantinib is a multikinase inhibitor approved in multiple malignancies. This is the first prospective trial to explore the anti-tumour activity, safety, and pharmacokinetic profile of cabozantinib in patients with advanced adrenocortical carcinoma. METHODS This investigator-initiated, single-arm, phase 2 trial in adult patients (aged ≥18 years) with advanced adrenocortical carcinoma was done at the University of Texas MD Anderson Cancer Center (Houston, TX, USA). Eligible patients had histologically confirmed adrenocortical carcinoma, were not candidates for surgery with curative intent, had measurable disease, had an estimated life expectancy of at least 3 months, and an Eastern Cooperative Oncology Group (ECOG) performance status of 0-2 with adequate organ function. Patients who had used mitotane within 6 months of study participation were required to have a serum mitotane level of less than 2 mg/L. Patients were given oral cabozantinib 60 mg daily with the option of dose reduction to manage adverse events. The primary endpoint was progression-free survival at 4 months, assessed in all patients who received at least one dose of study drug per protocol. This study is registered with ClinicalTrials.gov, NCT03370718, and is now complete. FINDINGS Between March 1, 2018, and May 31, 2021, we enrolled 18 patients (ten males and eight females), all of whom received at least one dose of study treatment. Of the 18 patients, eight (44%) had an ECOG performance status of 0, nine (50%) patients had a performance status of 1, and one (6%) patient had a performance status of 2. Median follow-up was 36·8 months (IQR 30·2-50·3). At 4 months, 13 (72·2%; 95% CI 46·5-90·3) of 18 patients had progression-free survival and median progression-free survival was 6 months (95% CI 4·3 to not reached). One patient remains on treatment. Treatment-related adverse events of grade 3 or worse occurred in 11 (61%) of 18 patients. The most common grade 3 adverse events were lipase elevation (three [17%] of 18 patients), elevated γ-glutamyl transferase concentrations (two [11%] patients), elevated alanine aminotransferase concentrations (two [11%] patients), hypophosphatemia (two [11%] patients), and hypertension (two [11%] patients). One (6%) of 18 patients had grade 4 hypertension. No treatment related deaths occurred on study. INTERPRETATION Cabozantinib in advanced adrenocortical carcinoma showed promising efficacy with a manageable and anticipated safety profile. Further prospective studies with cabozantinib alone and in combination with immune checkpoint therapy are ongoing. FUNDING Exelixis.
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Affiliation(s)
- Matthew T Campbell
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Vania Balderrama-Brondani
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Camilo Jimenez
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gina Tamsen
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Leonardo P Marcal
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeena Varghese
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amishi Y Shah
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - James P Long
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Miao Zhang
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Joshua Ochieng
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Cara Haymaker
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mouhammed Amir Habra
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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13
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Karri V, Lin H, Velazquez J, Batajoo A, Parekh D, Stanton W, Abhyankar H, El-Mallawany NK, Agrusa J, Eckstein O, Gulati N, Schwartz J, Woods-Swafford W, Boyd J, Saha A, Allen CE, McClain KL. Clinical, radiological and molecular responses to combination chemotherapy with MAPK pathway inhibition in relapsed and refractory Langerhans cell histiocytosis. Br J Haematol 2024; 204:1882-1887. [PMID: 38501390 DOI: 10.1111/bjh.19380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 02/19/2024] [Accepted: 02/21/2024] [Indexed: 03/20/2024]
Abstract
Optimal therapeutic approaches for advanced Langerhans cell histiocytosis (LCH) are not known. We assessed the safety and efficacy of combined chemotherapy with MAPK pathway inhibition in 10 patients with refractory systemic disease and/or LCH-associated neurodegeneration. Overall response rate was 9/10 (90%) for the entire cohort: 5/5 (100%) for patients with systemic disease and 6/7 (86%) for patients with central nervous system disease. BRAFV600E+ peripheral blood fraction decreased in 5/6 (83%). Toxicities included fever, skin rash, myalgias, neuropathy, cytopenias and hypocalcaemia. Prospective trials are required to optimize combination strategies, determine potential to achieve cure and compare outcomes to chemotherapy or MAPK inhibitor monotherapy.
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Affiliation(s)
- Vivekanudeep Karri
- Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas, USA
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Howard Lin
- Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas, USA
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Jessica Velazquez
- Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas, USA
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Akanksha Batajoo
- Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas, USA
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Deevyashali Parekh
- Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas, USA
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Whitney Stanton
- Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas, USA
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Harshal Abhyankar
- Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas, USA
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Nader K El-Mallawany
- Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas, USA
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Jennifer Agrusa
- Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas, USA
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Olive Eckstein
- Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas, USA
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Nitya Gulati
- Department of Pediatrics, Weill Cornell Medical College, New York, New York, USA
| | - Jeffrey Schwartz
- Studer Family Children's Hospital Pediatric Blood and Cancer, Pensacola, Florida, USA
| | - Wendy Woods-Swafford
- Unity Point Health, Blank Children's Hospital Cancer and Blood Disorders Clinic, Des Moines, Iowa, USA
| | - Jaime Boyd
- Pediatra Hematólogo y Oncólogo at Consultorios Royal Center, Panamá City, Panama
| | - Anikit Saha
- Prisma Health Cancer Institute, Greenville, South Carolina, USA
| | - Carl E Allen
- Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas, USA
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Kenneth L McClain
- Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas, USA
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
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14
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Xiang S, Shen R, Xiang J, Zhu N, Gu J, Shen J, Zhang Y, Ge H. A real-world pharmacovigilance study of FDA Adverse Event Reporting System (FAERS) events for Bruton's tyrosine kinase inhibitors (BTKis) single and its combination therapy. Expert Opin Drug Saf 2024; 23:627-636. [PMID: 38456691 DOI: 10.1080/14740338.2024.2327507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/03/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Bruton's tyrosine kinase inhibitors (BTKis) are targeted treatments for B-cell tumors but have significant side effects. This study assesses and contrasts the side effects of BTKis alone and its four combination therapies. RESEARCH DESIGN AND METHODS The reporting odds ratio (ROR) was used to analyze the data on three BTKis monotherapies and combinations of ibrutinib with rituximab, obinutuzumab, venetoclax, and lenalidomide in the FDA Adverse Event Reporting System (FAERS) database up to December 2022. RESULTS We analyzed the top 20 PTs for each treatment regimen. In monotherapies, atrial fibrillation (ROR (95% CI): 9.88 (9.47-10.32)) in zanubrutinib and rash (6.97 (5.42-8.98)) in acalabrutinib had higher associations. In combinations, infection (6.86 (6.11-7.70)), atrial fibrillation (27.96 (22.61-34.58)) and myelosuppression (10.09 (8.89-11.46)) were vital signals when ibrutinib was combined with obinutuzumab, and pyrexia (4.22 (2.57-6.93)) had a high signal value when combined with lenalidomide. Hemorrhage had a lower signal value when combined with venetoclax compared to ibrutinib alone (2.50 (2.18-2.87) vs 3.60 (3.52-3.68)). CONCLUSIONS The ibrutinib-obinutuzumab combo has the highest risk of infection, atrial fibrillation, and myelosuppression, and the ibrutinib-lenalidomide combo has the highest risk of pyrexia. However, the ibrutinib-venetoclax combo has a lower risk of hemorrhage than monotherapy.
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Affiliation(s)
- Sichun Xiang
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, China
| | - Rongbin Shen
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, China
| | - Jingjing Xiang
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, China
| | - Ni Zhu
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, China
| | - Jianyou Gu
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, China
| | - Jianping Shen
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, China
| | - Yu Zhang
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, China
| | - Hangping Ge
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, China
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15
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Schueller O, Regev G, Singh N, Willson A, Beville M, Kanji N, Lohmer L, Patel J. Two-Part Phase 1 Study to Evaluate the Taste Profile of Novel Belumosudil Oral Suspensions and Assess the Relative Bioavailability and Food Effect of the Selected Belumosudil Oral Suspension Compared With Oral Tablet Reference in Healthy Male Participants. Clin Pharmacol Drug Dev 2024; 13:491-498. [PMID: 38345529 DOI: 10.1002/cpdd.1378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/27/2023] [Indexed: 04/25/2024]
Abstract
Belumosudil is a selective rho-associated coiled-coil-containing protein kinase 2 inhibitor in clinical use for the treatment of chronic graft-versus-host disease. The current tablet formulation may be inappropriate for children or adults with dysphagia and/or upper gastrointestinal manifestations of chronic graft-versus-host disease. This study (NCT04735822) assessed the taste and palatability of oral suspensions of belumosudil, evaluated the relative bioavailability of an oral suspension versus the tablet formulation, and characterized the effect of food on the pharmacokinetics of an oral suspension. Addition of sweetener and/or flavor vehicle improved the taste. Relative bioavailability of 200-mg doses of the oral suspension and tablet in the fed state was similar for belumosudil and its metabolites (KD025m1 and KD025m2), but absorption was faster with the oral suspension (median time to maximum concentration: 2 vs 3 hours). Administration of the oral suspension with food increased exposure compared with fasted administration, with maximum observed concentration being increased by 16% and area under the concentration-time curve from time 0 to the last measurable concentration (AUC0-last) by 19%. Safety and tolerability were consistent with the known safety profile of belumosudil. These results may support administration of a 200-mg belumosudil oral suspension with or without food.
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Affiliation(s)
| | - Galit Regev
- Kadmon, A Sanofi Company, Cambridge, MA, USA
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16
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Su J, Ni C, Wu Y, Zhang J, Cai Z, Lu J, Lin S, Wang J. Comparative efficacy and safety of cabozantinib for malignant tumors: a systematic review and meta-analysis. Expert Rev Anticancer Ther 2024; 24:293-302. [PMID: 38551185 DOI: 10.1080/14737140.2024.2337266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 02/20/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES To provide a more comprehensive understanding of the efficacy and safety profile of cabozantinib versus placebo in malignant tumors, we conducted a systematic review and meta-analysis. This involved analyzing a collection of published randomized controlled trials to assess the outcomes. METHODS We used RevMan5.3 software to evaluate the outcomes of the collected studies. The primary outcome we focused on was progression-free survival (PFS), and the secondary outcomes included overall survival (OS) and disease control rate (DCR). RESULTS Our findings revealed that compared to placebo, cabozantinib significantly extended the PFS of patients [hazard ratios (HR) 0.37, 95% confidence intervals (CI): 0.32, 0.43, p < 0.00001]. Additionally, cabozantinib improved the OS of patients [HR 0.78, 95%CI: 0.68, 0.91, p = 0.002]. While it is important to note that cabozantinib was associated with a higher likelihood of causing digestive, cutaneous, and cardiovascular related adverse events [relative risk (RR) 4.40, 95% CI: 3.10, 6.25, p < 0.00001]. CONCLUSION Based on our analysis, cabozantinib significantly prolonged the PFS and OS of patients with malignant tumors (p < 0.01). We recommend the use of cabozantinib in treating advanced malignant tumors. However, it is important to continuously monitor and manage the drug-related adverse events. REGISTRATION PROSPERO (No. CRD42023449261).
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Affiliation(s)
- Jingyang Su
- Oncology Department, Hangzhou Hospital of Traditional Chinese Medicine affiliated to Zhejiang Chinese Medical University, Hangzhou, China
- General Internal Medicine Department, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Cui Ni
- Oncology Department, Hangzhou Hospital of Traditional Chinese Medicine affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Yuqian Wu
- Endocrinology Department, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jialin Zhang
- Oncology Department, Hangzhou Hospital of Traditional Chinese Medicine affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Zelin Cai
- Oncology Department, Hangzhou Hospital of Traditional Chinese Medicine affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Jinhua Lu
- Oncology Department, Hangzhou Hospital of Traditional Chinese Medicine affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Shengyou Lin
- Department of Oncology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Jue Wang
- Oncology Department, Hangzhou Hospital of Traditional Chinese Medicine affiliated to Zhejiang Chinese Medical University, Hangzhou, China
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Corcoran RB, Do KT, Kim JE, Cleary JM, Parikh AR, Yeku OO, Xiong N, Weekes CD, Veneris J, Ahronian LG, Mauri G, Tian J, Norden BL, Michel AG, Van Seventer EE, Siravegna G, Camphausen K, Chi G, Fetter IJ, Brugge JS, Chen H, Takebe N, Penson RT, Juric D, Flaherty KT, Sullivan RJ, Clark JW, Heist RS, Matulonis UA, Liu JF, Shapiro GI. Phase I/II Study of Combined BCL-xL and MEK Inhibition with Navitoclax and Trametinib in KRAS or NRAS Mutant Advanced Solid Tumors. Clin Cancer Res 2024; 30:1739-1749. [PMID: 38456660 PMCID: PMC11061595 DOI: 10.1158/1078-0432.ccr-23-3135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/11/2023] [Accepted: 02/26/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE MEK inhibitors (MEKi) lack monotherapy efficacy in most RAS-mutant cancers. BCL-xL is an anti-apoptotic protein identified by a synthetic lethal shRNA screen as a key suppressor of apoptotic response to MEKi. PATIENTS AND METHODS We conducted a dose escalation study (NCT02079740) of the BCL-xL inhibitor navitoclax and MEKi trametinib in patients with RAS-mutant tumors with expansion cohorts for: pancreatic, gynecologic (GYN), non-small cell lung cancer (NSCLC), and other cancers harboring KRAS/NRAS mutations. Paired pretreatment and day 15 tumor biopsies and serial cell-free (cf)DNA were analyzed. RESULTS A total of 91 patients initiated treatment, with 38 in dose escalation. Fifty-eight percent had ≥3 prior therapies. A total of 15 patients (17%) had colorectal cancer, 19 (11%) pancreatic, 15 (17%) NSCLC, and 32 (35%) GYN cancers. The recommended phase II dose (RP2D) was established as trametinib 2 mg daily days 1 to 14 and navitoclax 250 mg daily days 1 to 28 of each cycle. Most common adverse events included diarrhea, thrombocytopenia, increased AST/ALT, and acneiform rash. At RP2D, 8 of 49 (16%) evaluable patients achieved partial response (PR). Disease-specific differences in efficacy were noted. In patients with GYN at the RP2D, 7 of 21 (33%) achieved a PR and median duration of response 8.2 months. No PRs occurred in patients with colorectal cancer, NSCLC, or pancreatic cancer. MAPK pathway inhibition was observed in on-treatment tumor biopsies. Reductions in KRAS/NRAS mutation levels in cfDNA correlated with clinical benefit. CONCLUSIONS Navitoclax in combination with trametinib was tolerable. Durable clinical responses were observed in patients with RAS-mutant GYN cancers, warranting further evaluation in this population.
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Affiliation(s)
- Ryan B. Corcoran
- Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Khanh T. Do
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jeong E. Kim
- Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - James M. Cleary
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Aparna R. Parikh
- Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Oladapo O. Yeku
- Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Niya Xiong
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Colin D. Weekes
- Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Jennifer Veneris
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Leanne G. Ahronian
- Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Gianluca Mauri
- Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, and Department of Hematology Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Jun Tian
- Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Bryanna L. Norden
- Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Alexa G. Michel
- Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Emily E. Van Seventer
- Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Giulia Siravegna
- Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Kyle Camphausen
- Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Gary Chi
- Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Isobel J. Fetter
- Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Joan S. Brugge
- Department of Cell Biology, Harvard Medical School, Boston, Massachusetts
| | - Helen Chen
- National Institute of Health, National Cancer Institute, Division of Cancer Treatment and Diagnosis, Cancer Therapy Evaluation Program, Bethesda, Maryland
| | - Naoko Takebe
- National Institute of Health, National Cancer Institute, Division of Cancer Treatment and Diagnosis, Cancer Therapy Evaluation Program, Bethesda, Maryland
| | - Richard T. Penson
- Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Dejan Juric
- Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Keith T. Flaherty
- Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Ryan J. Sullivan
- Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Jeffrey W. Clark
- Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Rebecca S. Heist
- Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Ursula A. Matulonis
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Joyce F. Liu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Geoffrey I. Shapiro
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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Dickinson A, Liu Y, Uvarov A, Peyret T, Marier JF, Chin C, Tran JQ. Concentration-QTc modeling of sitravatinib in patients with advanced solid malignancies. Clin Transl Sci 2024; 17:e13808. [PMID: 38700272 PMCID: PMC11067505 DOI: 10.1111/cts.13808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/26/2024] [Accepted: 03/26/2024] [Indexed: 05/05/2024] Open
Abstract
Sitravatinib (MGCD516) is an orally available, small molecule, tyrosine kinase inhibitor that has been evaluated in patients with advanced solid tumors. Concentration-corrected QT interval (QTc; C-QTc) modeling was undertaken, using 767 matched concentration-ECG observations from 187 patients across two clinical studies in patients with advanced solid malignancies, across a dose range of 10-200 mg, via a linear mixed-effects (LME) model. The effect on heart rate (HR)-corrected QT interval via Fridericia's correction method (QTcF) at the steady-state maximum concentration (Cmax,ss) for the sitravatinib proposed therapeutic dosing regimen (100 mg malate once daily [q.d.]) without and with relevant intrinsic and extrinsic factors were predicted. No significant changes in HR from baseline were observed. Hysteresis between sitravatinib plasma concentration and change in QTcF from baseline (ΔQTcF) was not observed. There was no significant relationship between sitravatinib plasma concentration and ΔQTcF. The final C-QTc model predicted a mean (90% confidence interval [CI]) ΔQTcF of 3.92 (1.95-5.89) ms and 2.94 (0.23-6.10) ms at the proposed therapeutic dosing regimen in patients with normal organ function (best case scenario) and patients with hepatic impairment (worst-case scenario), respectively. The upper bounds of the 90% CIs were below the regulatory threshold of concern of 10 ms. The results of the described C-QTc analysis, along with corroborating results from nonclinical safety pharmacology studies, indicate that sitravatinib has a low risk of QTc interval prolongation at the proposed therapeutic dose of 100 mg malate q.d.
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Affiliation(s)
| | - Yong Liu
- Mirati Therapeutics IncSan DiegoCaliforniaUSA
| | - Artem Uvarov
- Certara Drug Development SolutionsPrincetonNew JerseyUSA
| | - Thomas Peyret
- Certara Drug Development SolutionsPrincetonNew JerseyUSA
| | - J. F. Marier
- Certara Drug Development SolutionsPrincetonNew JerseyUSA
| | - Curtis Chin
- Mirati Therapeutics IncSan DiegoCaliforniaUSA
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19
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Rajeh A, Ferree S, Anadkat MJ. Radiation Recall Dermatitis With Bruton Tyrosine Kinase Inhibitor Therapy. JAMA Dermatol 2024; 160:577-578. [PMID: 38536185 DOI: 10.1001/jamadermatol.2024.0124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
This case report describes a woman in her 70s with a history of breast cancer and chronic lymphocytic leukemia who presented with a painful rash of the bilateral chest extending onto the flanks.
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Affiliation(s)
- Ahmad Rajeh
- Divsion of Dermatology, Washington University School of Medicine, St Louis, Missouri
| | - Sarah Ferree
- Divsion of Dermatology, Washington University School of Medicine, St Louis, Missouri
| | - Milan J Anadkat
- Divsion of Dermatology, Washington University School of Medicine, St Louis, Missouri
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Cheng Q, Shi X, Zhao Y, Zou S, Sun M. Post-marketing safety concerns with palbociclib: a disproportionality analysis of the FDA adverse event reporting system. Expert Opin Drug Saf 2024; 23:637-648. [PMID: 38564277 DOI: 10.1080/14740338.2024.2338247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/17/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES To explore the association between palbociclib and related adverse events (AEs) in the real world through U.S. Food and Drug Administration Adverse Event Reporting System (FAERS) database. METHODS The signal strength of palbociclib-related AEs was done by disproportionality analysis. Clinical priority of palbociclib-related AEs was scored and ranked by assessing five different features. Outcome analysis, time to onset analysis, dose-report /AEs number analysis, and stratification analysis were all performed. RESULTS There were 61,821 'primary suspected (PS)' reports of palbociclib and 195,616 AEs associated with palbociclib. The four algorithms simultaneously detected 18 positive signals at the SOC level, and 65 positive signals at the PT level. Bone marrow failure, neuropathy, peripheral, pleural effusion, myelosuppression, pulmonary edema, and pulmonary thrombosis were also found to have positive signals. Gender (female vs male, χ2 = 5.287, p = 0.022) and age showed significant differences in serious and non-serious reports. Palbociclib-related AEs had a median onset time of 79 days (interquartile range [IQR] 20-264 days). CONCLUSIONS The study identified potential Palbociclib-related AEs and offered warnings for special AEs, providing further data for palbociclib safety studies in breast cancer patients. Nonetheless, prospective clinical trials are needed to validate these results and explain their relationship.
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Affiliation(s)
- Qian Cheng
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xuan Shi
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yazheng Zhao
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shupeng Zou
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Minghui Sun
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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21
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Matsushita Y, Kojima T, Osawa T, Sazuka T, Hatakeyama S, Goto K, Numakura K, Yamana K, Kandori S, Fujita K, Ueda K, Tanaka H, Tomida R, Kurahashi T, Bando Y, Nishiyama N, Kimura T, Yamashita S, Kitamura H, Miyake H. Prognostic outcomes in patients with metastatic renal cell carcinoma receiving second-line treatment with tyrosine kinase inhibitor following first-line immune-oncology combination therapy. Int J Urol 2024; 31:526-533. [PMID: 38240169 DOI: 10.1111/iju.15396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/04/2024] [Indexed: 05/05/2024]
Abstract
OBJECTIVES This study aimed to assess the prognostic outcomes in mRCC patients receiving second-line TKI following first-line IO combination therapy. METHODS This study retrospectively included 243 mRCC patients receiving second-line TKI after first-line IO combination therapy: nivolumab plus ipilimumab (n = 189, IO-IO group) and either pembrolizumab plus axitinib or avelumab plus axitinib (n = 54, IO-TKI group). Oncological outcomes between the two groups were compared, and prognostication systems were developed for these patients. RESULTS In the IO-IO and IO-TKI groups, the objective response rates to second-line TKI were 34.4% and 25.9% (p = 0.26), the median PFS periods were 9.7 and 7.1 months (p = 0.79), and the median OS periods after the introduction of second-line TKI were 23.1 and 33.5 months (p = 0.93), respectively. Among the several factors examined, non-CCRCC, high CRP, and low albumin levels were identified as independent predictors of both poor PFS and OS by multivariate analyses. It was possible to precisely classify the patients into 3 risk groups regarding both PFS and OS according to the positive numbers of the independent prognostic factors. Furthermore, the c-indices of this study were superior to those of previous systems as follows: 0.75, 0.64, and 0.61 for PFS prediction and 0.76, 0.70, and 0.65 for OS prediction by the present, IMDC, and MSKCC systems, respectively. CONCLUSIONS There were no significant differences in the prognostic outcomes after introducing second-line TKI between the IO-IO and IO-TKI groups, and the histopathology, CRP and albumin levels had independent impacts on the prognosis in mRCC patients receiving second-line TKI, irrespective of first-line IO combination therapies.
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Affiliation(s)
- Yuto Matsushita
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Takahiro Kojima
- Department of Urology, Aichi Cancer Center, Nagoya, Aichi, Japan
| | - Takahiro Osawa
- Department of Renal and Genitourinary Surgery, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Tomokazu Sazuka
- Department of Urology, Graduate School of Medicine and School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Shingo Hatakeyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Keisuke Goto
- Department of Urology, Graduate School of Biomedical Science, Hiroshima University, Hiroshima, Hiroshima, Japan
| | - Kazuyuki Numakura
- Department of Urology, Akita University Graduate School of Medicine, Akita, Akita, Japan
| | - Kazutoshi Yamana
- Department of Urology and Molecular Oncology, Niigata University Graduate school of medical and dental sciences, Niigata, Niigata, Japan
| | - Shuya Kandori
- Department of Urology, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Kazutoshi Fujita
- Department of Urology, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Kosuke Ueda
- Department of Urology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Hajime Tanaka
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ryotaro Tomida
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
| | - Toshifumi Kurahashi
- Department of Urology, Hyogo Prefectural Cancer Center, Akashi, Hyogo, Japan
| | - Yukari Bando
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Naotaka Nishiyama
- Department of Urology, Faculty of Medicine, University of Toyama, Toyama, Toyama, Japan
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shimpei Yamashita
- Department of Urology, Wakayama Medical University, Wakayama, Wakayama, Japan
| | - Hiroshi Kitamura
- Department of Urology, Faculty of Medicine, University of Toyama, Toyama, Toyama, Japan
| | - Hideaki Miyake
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
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Garmezy B, Borad MJ, Bahleda R, Perez CA, Chen LT, Kato S, Oh DY, Severson P, Tam BY, Quah CS, Harding JJ. A Phase I Study of KIN-3248, an Irreversible Small-molecule Pan-FGFR Inhibitor, in Patients with Advanced FGFR2/3-driven Solid Tumors. Cancer Res Commun 2024; 4:1165-1173. [PMID: 38602417 PMCID: PMC11060137 DOI: 10.1158/2767-9764.crc-24-0137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/05/2024] [Accepted: 04/09/2024] [Indexed: 04/12/2024]
Abstract
PURPOSE Despite efficacy of approved FGFR inhibitors, emergence of polyclonal secondary mutations in the FGFR kinase domain leads to acquired resistance. KIN-3248 is a selective, irreversible, orally bioavailable, small-molecule inhibitor of FGFR1-4 that blocks both primary oncogenic and secondary kinase domain resistance FGFR alterations. EXPERIMENTAL DESIGN A first-in-human, phase I study of KIN-3248 was conducted in patients with advanced solid tumors harboring FGFR2 and/or FGFR3 gene alterations (NCT05242822). The primary objective was determination of MTD/recommended phase II dose (RP2D). Secondary and exploratory objectives included antitumor activity, pharmacokinetics, pharmacodynamics, and molecular response by circulating tumor DNA (ctDNA) clearance. RESULTS Fifty-four patients received doses ranging from 5 to 50 mg orally daily across six cohorts. Intrahepatic cholangiocarcinoma (48.1%), gastric (9.3%), and urothelial (7.4%) were the most common tumors. Tumors harbored FGFR2 (68.5%) or FGFR3 (31.5%) alterations-23 (42.6%) received prior FGFR inhibitors. One dose-limiting toxicity (hypersensitivity) occurred in cohort 1 (5 mg). Treatment-related, adverse events included hyperphosphatemia, diarrhea, and stomatitis. The MTD/RP2D was not established. Exposure was dose proportional and concordant with hyperphosphatemia. Five partial responses were observed; 4 in FGFR inhibitor naïve and 1 in FGFR pretreated patients. Pretreatment ctDNA profiling confirmed FGFR2/3 alterations in 63.3% of cases and clearance at cycle 2 associated with radiographic response. CONCLUSION The trial was terminated early for commercial considerations; therefore, RP2D was not established. Preliminary clinical data suggest that KIN-3248 is a safe, oral FGFR1-4 inhibitor with favorable pharmacokinetic parameters, though further dose escalation was required to nominate the MTD/RP2D. SIGNIFICANCE KIN-3248 was a rationally designed, next generation selective FGFR inhibitor, that was effective in interfering with both FGFR wild-type and mutant signaling. Clinical data indicate that KIN-3248 is safe with a signal of antitumor activity. Translational science support the mechanism of action in that serum phosphate was proportional with exposure, paired biopsies suggested phospho-ERK inhibition (a downstream target of FGFR2/3), and ctDNA clearance may act as a RECIST response surrogate.
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Affiliation(s)
| | | | - Rastilav Bahleda
- Drug Development Department (DITEP), Gustave Roussy, Villejuif, France
| | - Cesar A. Perez
- Sarah Cannon Research Institute at Florida Cancer Specialists, Orlando, Florida
| | - Li-Tzong Chen
- Kaohsiung Medical University Hospital and Center for Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shumei Kato
- Division of Hematology and Oncology, Department of Medicine, UC San Diego Moores Cancer Center, La Jolla, California
| | - Do-Youn Oh
- Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Integrated Major in Innovative Medical Science, Seoul National University Graduate School, Seoul, Republic of South Korea
| | | | - Betty Y. Tam
- Formerly Kinnate Biopharma, San Francisco, California
| | | | - James J. Harding
- Gastrointestinal Oncology and Early Drug Development Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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23
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Phillips WJ, Leighl NB, Blais N, Wheatley-Price P. Oral targeted therapy for the treatment of non-small cell lung carcinoma. CMAJ 2024; 196:E558-E561. [PMID: 38684283 PMCID: PMC11057882 DOI: 10.1503/cmaj.231562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Affiliation(s)
- William J Phillips
- Department of Medicine (Phillips, Wheatley-Price), University of Ottawa, Ottawa, Ont.; Department of Medicine (Leighl), Princess Margaret Cancer Centre, University of Toronto, Toronto, Ont.; Department of Medicine (Blais), Centre hospitalier de l'Université de Montréal, University of Montreal, Montréal, Que.; the Ottawa Hospital Research Institute (Wheatley-Price), Ottawa, Ont
| | - Natasha B Leighl
- Department of Medicine (Phillips, Wheatley-Price), University of Ottawa, Ottawa, Ont.; Department of Medicine (Leighl), Princess Margaret Cancer Centre, University of Toronto, Toronto, Ont.; Department of Medicine (Blais), Centre hospitalier de l'Université de Montréal, University of Montreal, Montréal, Que.; the Ottawa Hospital Research Institute (Wheatley-Price), Ottawa, Ont
| | - Normand Blais
- Department of Medicine (Phillips, Wheatley-Price), University of Ottawa, Ottawa, Ont.; Department of Medicine (Leighl), Princess Margaret Cancer Centre, University of Toronto, Toronto, Ont.; Department of Medicine (Blais), Centre hospitalier de l'Université de Montréal, University of Montreal, Montréal, Que.; the Ottawa Hospital Research Institute (Wheatley-Price), Ottawa, Ont
| | - Paul Wheatley-Price
- Department of Medicine (Phillips, Wheatley-Price), University of Ottawa, Ottawa, Ont.; Department of Medicine (Leighl), Princess Margaret Cancer Centre, University of Toronto, Toronto, Ont.; Department of Medicine (Blais), Centre hospitalier de l'Université de Montréal, University of Montreal, Montréal, Que.; the Ottawa Hospital Research Institute (Wheatley-Price), Ottawa, Ont.
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24
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Patell K, Mears VL, Storandt MH, Mahipal A. Metabolism, toxicity and management of fruquintinib: a novel drug for metastatic colorectal cancer. Expert Opin Drug Metab Toxicol 2024; 20:197-205. [PMID: 38497279 DOI: 10.1080/17425255.2024.2332364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/15/2024] [Indexed: 03/19/2024]
Abstract
INTRODUCTION Colorectal cancer (CRC) is the third most diagnosed cancer globally and despite therapeutic strides, the prognosis for patients with metastatic disease (mCRC) remains poor. Fruquintinib is an oral vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitor (TKI) targeting VEGFR -1, -2, and -3, and has recently received approval by the U.S. Food and Drug Administration for treatment of mCRC refractory to standard chemotherapy, anti-VEGF therapy, and anti-epidermal growth factor receptor (EGFR) therapy. AREAS COVERED This article provides an overview of the pre-clinical data, pharmacokinetics, clinical efficacy, and safety profile of fruquintinib, as well as the management of clinical toxicities associated with fruquintinib. EXPERT OPINION Fruquintinib is a valuable additional treatment option for patients with refractory mCRC. The pivotal role of vigilant toxicity management cannot be understated. While fruquintinib offers a convenient and overall, well-tolerated treatment option, ongoing research is essential to determine its efficacy in different patient subsets, evaluate it in combination with chemotherapy and immunotherapy, and determine its role in earlier lines of therapy.
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Affiliation(s)
- Kanchi Patell
- Hematology and Oncology Fellow, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, USA
| | - Veronica Lee Mears
- GI Oncology Clinical Pharmacist Specialist, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, USA
| | | | - Amit Mahipal
- University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, USA
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25
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Peng Y, Huang J, Yin J, Meng F, Cao Y, Huang L, Li D, Zhang Y, Zhang D, Meng L, Han Z, Hong Z. Frontline combination of dasatinib and low-intensity chemotherapy in adults with de novo Philadelphia chromosome-positive acute lymphoblastic leukemia. Expert Rev Hematol 2024; 17:173-180. [PMID: 38616308 DOI: 10.1080/17474086.2024.2343885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 03/19/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Studies on dasatinib-based low-intensity induction regimens and post-remission strategies are limited in China. Therefore, we conducted a single-center phase 2 trial in newly diagnosed adult patients with Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia (ALL) to establish the efficacy and safety of this treatment approach. RESEARCH DESIGN AND METHODS Patients received one month of dasatinib plus low-intensity chemotherapy and two months of dasatinib monotherapy for induction, followed by a single course of high-dose methotrexate for consolidation. Subsequently, they underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) or tyrosine kinase inhibitor (TKI)-based treatment for maintenance therapy between October 2015 and August 2022. RESULTS Twenty-two patients were enrolled. Median age was 45 years (range, 20-71). The rates of major and complete molecular responses in the third month were 18.2% and 40.9% respectively. With a median follow-up of 15 months (range, 5-89), the estimated 3-year disease-free survival (DFS) and overall survival (OS) were 52.4% and 73.2%, respectively. The TKI-based cohort had a significantly poorer DFS (p = 0.014) and OS (p = 0.008) than the allo-HSCT cohort. CONCLUSIONS Our results suggest that dasatinib-based low-intensity chemotherapy is safe and effective as an induction strategy in the Chinese population. Allo-HSCT plays a crucial role in the long-term outcomes of patients with Ph+ ALL. CLINICAL TRIAL REGISTRATION The trial was registered at ClinicalTrials.gov as NCT02690922.
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Affiliation(s)
- Yizhou Peng
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Jinjin Huang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Jin Yin
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Fankai Meng
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Yang Cao
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Liang Huang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Dengju Li
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Yicheng Zhang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Donghua Zhang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Li Meng
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Zhiqiang Han
- Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Zhenya Hong
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
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Huang S, Kang X, Wang C, Zhang W, Jiang J, Kang Z, Yang S, Chen J, Chen F, Li W. Outcomes, responses, and prognostic analyses of intrathecal combined treatment for leptomeningeal metastasis from lung adenocarcinoma. J Cancer Res Ther 2024; 20:658-664. [PMID: 38687937 DOI: 10.4103/jcrt.jcrt_2071_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/12/2023] [Indexed: 05/02/2024]
Abstract
BACKGROUND Leptomeningeal metastasis (LM) is a severe lung cancer complication, with potentially fatal consequences. The use of intrathecal therapy (IT) combined with systemic therapy has shown promise as a treatment approach for LM. Thus, this study aimed to evaluate the features and responses to IT combined therapy and identify determinants affecting patients with leptomeningeal metastasis resulting from lung adenocarcinoma (LM-LA). METHODS A retrospective analysis of medical records from our hospital database was performed, covering from April 2018 to August 2022, for 37 patients diagnosed with LM-LA and treated with IT combined therapy. Patients who received IT combined therapy for LM-LA were evaluated for demographic characteristics, treatment efficacy, survival, and variables that impacted them. RESULTS The median overall survival (mOS) of 37 patients was 16.0 months, and the survival rates at 6 and 12 months were 75.7% and 35.1%, respectively. Among the 21 patients with LM-LA who received IT combined with tyrosine kinase inhibitors (TKIs), the mOS was 17.0 months, which was significantly longer than that of patients treated with IT combined with chemotherapy (7.0 months, P = 0.010) and the best supportive care (6.0 months, P = 0.001). However, no significant survival benefit was observed in patients treated with IT combined with TKIs when compared with those treated with IT combined with PD-1 (5.0 months, P = 0.249). Multivariate analysis indicated that the combination of TKIs was an independent favorable prognostic factor for patients with LM-LA. CONCLUSION Combination treatment is regarded as an additional option for patients with LM-LA. Compared with other combination therapies in our study, IT combined with TKI therapy provided a better survival outcome for patients with LM-LA.
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Affiliation(s)
- Sijie Huang
- Department of Neuro-Oncology, Cancer Center, Beijing Tiantan Hospital, Capital Medical University, Fengtai District, Beijing, China
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27
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Kulkarni A, Singh J. Predicting drug-drug interactions in breast cancer patients treated with CDK4/6 inhibitors and forward planning. Expert Opin Drug Metab Toxicol 2024; 20:225-233. [PMID: 38600865 DOI: 10.1080/17425255.2024.2341810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 04/05/2024] [Indexed: 04/12/2024]
Abstract
INTRODUCTION Cyclin-dependent kinase (CDK) 4/6 inhibitors are cornerstones in the treatment of Hormone Receptor (HR) positive and Human Epidermal Growth factor (HER2) negative metastatic breast cancer. Given their widespread use in the metastatic setting and emerging use in the adjuvant setting, studying drug-drug interactions (DDI) of these medications is of utmost importance. AREAS COVERED This review provides key background information on the CDK4/6 inhibitors, palbociclib, ribociclib, and abemaciclib. We discuss drug-drug interactions including those with proton pump inhibitors as well as CYP3A substrates, inhibitors, and inducers. We describe the effect of these drugs on membrane transporters and their substrates as well as those drugs that increase risk of CDK4/6 toxicities. Finally, we explore future directions for strategies to minimize drug-drug interactions. EXPERT OPINION It is crucial to be mindful of medications that may interfere with drug absorption, such as proton pump inhibitors, as well as those that interfere with drug metabolism, such as CYP3A4 inhibitors and inducers. Additionally, special consideration should be given to populations at higher risk for polypharmacy, such as older patients with greater comorbidities. These interactions and patient characteristics should be considered when developing individual treatment plans with CDK4/6 inhibitors.
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Affiliation(s)
- Abha Kulkarni
- Department of Medicine, New York Presbyterian Weill Cornell, New York, NY USA
| | - Jasmeet Singh
- Department of Breast Medicine, Memorial Sloan Kettering Cancer Center, West Harrison, NY USA
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28
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Gautam A, Boyd DF, Nikhar S, Zhang T, Siokas I, Van de Velde LA, Gaevert J, Meliopoulos V, Thapa B, Rodriguez DA, Cai KQ, Yin C, Schnepf D, Beer J, DeAntoneo C, Williams RM, Shubina M, Livingston B, Zhang D, Andrake MD, Lee S, Boda R, Duddupudi AL, Crawford JC, Vogel P, Loch C, Schwemmle M, Fritz LC, Schultz-Cherry S, Green DR, Cuny GD, Thomas PG, Degterev A, Balachandran S. Necroptosis blockade prevents lung injury in severe influenza. Nature 2024; 628:835-843. [PMID: 38600381 DOI: 10.1038/s41586-024-07265-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 03/01/2024] [Indexed: 04/12/2024]
Abstract
Severe influenza A virus (IAV) infections can result in hyper-inflammation, lung injury and acute respiratory distress syndrome1-5 (ARDS), for which there are no effective pharmacological therapies. Necroptosis is an attractive entry point for therapeutic intervention in ARDS and related inflammatory conditions because it drives pathogenic lung inflammation and lethality during severe IAV infection6-8 and can potentially be targeted by receptor interacting protein kinase 3 (RIPK3) inhibitors. Here we show that a newly developed RIPK3 inhibitor, UH15-38, potently and selectively blocked IAV-triggered necroptosis in alveolar epithelial cells in vivo. UH15-38 ameliorated lung inflammation and prevented mortality following infection with laboratory-adapted and pandemic strains of IAV, without compromising antiviral adaptive immune responses or impeding viral clearance. UH15-38 displayed robust therapeutic efficacy even when administered late in the course of infection, suggesting that RIPK3 blockade may provide clinical benefit in patients with IAV-driven ARDS and other hyper-inflammatory pathologies.
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Affiliation(s)
- Avishekh Gautam
- Center for Immunology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - David F Boyd
- Department of Immunology, St Jude Children's Research Hospital, Memphis, TN, USA
- Department of Host-Microbe Interactions, St Jude Children's Research Hospital, Memphis, TN, USA
- Department of Molecular, Cell and Developmental Biology, University of California, Santa Cruz, CA, USA
| | - Sameer Nikhar
- Department of Pharmacological and Pharmaceutical Sciences, University of Houston, Houston, TX, USA
| | - Ting Zhang
- Center for Immunology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Ioannis Siokas
- Department of Developmental, Molecular and Chemical Biology, Tufts University School of Medicine, Boston, MA, USA
| | - Lee-Ann Van de Velde
- Department of Host-Microbe Interactions, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Jessica Gaevert
- Department of Host-Microbe Interactions, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Victoria Meliopoulos
- Department of Host-Microbe Interactions, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Bikash Thapa
- Center for Immunology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Diego A Rodriguez
- Department of Immunology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Kathy Q Cai
- Center for Immunology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Chaoran Yin
- Center for Immunology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Daniel Schnepf
- Institute of Virology Department for Medical Microbiology and Hygiene, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Julius Beer
- Institute of Virology Department for Medical Microbiology and Hygiene, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Carly DeAntoneo
- Center for Immunology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Riley M Williams
- Center for Immunology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Maria Shubina
- Center for Immunology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Brandi Livingston
- Department of Host-Microbe Interactions, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Dingqiang Zhang
- Department of Developmental, Molecular and Chemical Biology, Tufts University School of Medicine, Boston, MA, USA
| | - Mark D Andrake
- Center for Immunology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Seungheon Lee
- Department of Pharmacological and Pharmaceutical Sciences, University of Houston, Houston, TX, USA
| | - Raghavender Boda
- Department of Pharmacological and Pharmaceutical Sciences, University of Houston, Houston, TX, USA
| | - Anantha L Duddupudi
- Department of Pharmacological and Pharmaceutical Sciences, University of Houston, Houston, TX, USA
| | - Jeremy Chase Crawford
- Department of Host-Microbe Interactions, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Peter Vogel
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Martin Schwemmle
- Institute of Virology Department for Medical Microbiology and Hygiene, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Stacey Schultz-Cherry
- Department of Host-Microbe Interactions, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Douglas R Green
- Department of Immunology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Gregory D Cuny
- Department of Pharmacological and Pharmaceutical Sciences, University of Houston, Houston, TX, USA.
| | - Paul G Thomas
- Department of Immunology, St Jude Children's Research Hospital, Memphis, TN, USA.
- Department of Host-Microbe Interactions, St Jude Children's Research Hospital, Memphis, TN, USA.
| | - Alexei Degterev
- Department of Developmental, Molecular and Chemical Biology, Tufts University School of Medicine, Boston, MA, USA.
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Tang H, Ge Y, You T, Li X, Wang Y, Cheng Y, Bai C. A real-world analysis of trametinib in combination with hydroxychloroquine or CDK4/6 inhibitor as third- or later-line therapy in metastatic pancreatic adenocarcinoma. BMC Cancer 2023; 23:958. [PMID: 37817078 PMCID: PMC10563303 DOI: 10.1186/s12885-023-11464-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 09/28/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND There are no standard third-line treatment options for metastatic pancreatic ductal adenocarcinoma (mPDAC). Trametinib in combination with hydroxychloroquine (HCQ) or CDK4/6 inhibitors for pancreatic adenocarcinoma showed promising efficacy in preclinical studies. However, the regimens have not been well examined in patients with mPDAC. METHODS Patients with mPDAC who received the combination of trametinib and HCQ or CDK4/6 inhibitors as third- or later-line therapy were reviewed. The efficacy and prognosis were further analyzed. RESULTS A total of 13 mPDAC patients were enrolled, of whom 8 and 5 patients were treated with trametinib plus HCQ or a CDK4/6 inhibitor (palbociclib or abemaciclib), respectively. All enrolled patients had either KRAS G12D or G12V mutations and had received a median of 3 prior lines of therapy (range, 2-6). The median trametinib treatment duration was 1.4 months. Of the 10 patients with measurable disease, only 1 patient achieved stable disease, and the remaining patients had progressive disease. Moreover, in patients treated with trametinib plus HCQ and a CDK4/6 inhibitor, the median progression-free survival was 2.0 and 2.8 months, respectively, and the median overall survival was 4.2 and 4.7 months, respectively. Moreover, 5 (50%) patients experienced grade 3-4 adverse events in 10 patients with available safety data. CONCLUSIONS The combination of trametinib and HCQ or CDK4/6 inhibitors may not be an effective later-line treatment for mPDAC, and the current preliminary findings need to be confirmed by other studies with larger sample sizes.
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Affiliation(s)
- Hui Tang
- Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yuping Ge
- Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Tingting You
- Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiaoyuan Li
- Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yingyi Wang
- Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yuejuan Cheng
- Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
| | - Chunmei Bai
- Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
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30
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Cao B, Huang L, Liu M, Lin H, Ma T, Zhao Y, Geng Y, Yang Y, Guo H, Li J. Phase 1 study to evaluate the effects of rifampin or itraconazole on the pharmacokinetics of limertinib (ASK120067), a novel mutant-selective inhibitor of the epidermal growth factor receptor in healthy Chinese subjects. Expert Opin Drug Metab Toxicol 2023; 19:653-664. [PMID: 37811634 DOI: 10.1080/17425255.2023.2260738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/31/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Limertinib is a novel mutant-selective and irreversible inhibitor of the epidermal growth factor receptor under development. A phase 1 open, two-period, single-sequence, self-controlled, two-part study was initiated to characterize the effects of a strong CYP3A4 inducer (rifampin) or inhibitor (itraconazole) on the pharmacokinetics of limertinib. RESEARCH DESIGN AND METHODS Twenty-four healthy subjects in each part received a single dose of limertinib alone (160 mg, Part A; 80 mg, Part B) and with multiple doses of rifampin 600 mg once daily (Part A) or itraconazole 200 mg twice daily (Part B). RESULTS Coadministration of rifampin decreased exposure (area under the plasma concentration-time curve from time 0 to infinity, AUC0-inf) of limertinib and its active metabolite CCB4580030 by 87.86% (geometric least-squares mean [GLSM] ratio, 12.14%; 90% confidence interval [CI], 9.89-14.92) and 66.82% (GLSM ratio, 33.18%; 90% CI, 27.72-39.72), respectively. Coadministration of itraconazole increased the AUC0-inf of limertinib by 289.8% (GLSM ratio, 389.8%; 90% CI, 334.07-454.82), but decreased that of CCB4580030 by 35.96% (GLSM ratio, 64.04%; 90% CI, 50.78-80.77). CONCLUSIONS Our study demonstrates that the concomitant use of limertinib with strong CYP3A inducers or inhibitors is not recommended. A single dose of limertinib, administered with or without rifampin or itraconazole, is generally safe and well tolerated in healthy Chinese subjects. CLINICAL TRIAL REGISTRATION www.clinicaltrials.gov identifier is NCT05631678.
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Affiliation(s)
- Bei Cao
- Phase I Clinical Trials Unit, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Lei Huang
- Phase I Clinical Trials Unit, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Ming Liu
- Clinical Pharmacology Department, Jiangsu Aosaikang Pharmaceutical Co. Ltd, Nanjing, China
| | - Hui Lin
- Phase I Clinical Trials Unit, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Tingting Ma
- Phase I Clinical Trials Unit, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Yu Zhao
- Phase I Clinical Trials Unit, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Yan Geng
- Phase I Clinical Trials Unit, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Yuanxun Yang
- Phase I Clinical Trials Unit, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Haifang Guo
- Clinical Pharmacology Department, Jiangsu Aosaikang Pharmaceutical Co. Ltd, Nanjing, China
| | - Juan Li
- Phase I Clinical Trials Unit, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
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Rotow J, Patel JD, Hanley MP, Yu H, Awad M, Goldman JW, Nechushtan H, Scheffler M, S Kuo CH, Rajappa S, Harada G, Clifford S, Santucci A, Silva L, Tupper R, Oxnard GR, Kherani J, Drilon A. Osimertinib and Selpercatinib Efficacy, Safety, and Resistance in a Multicenter, Prospectively Treated Cohort of EGFR-Mutant and RET Fusion-Positive Lung Cancers. Clin Cancer Res 2023; 29:2979-2987. [PMID: 36996322 PMCID: PMC10524391 DOI: 10.1158/1078-0432.ccr-22-2189] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/13/2023] [Accepted: 03/27/2023] [Indexed: 04/01/2023]
Abstract
PURPOSE Acquired RET fusions have been reported at resistance to treatment with EGFR inhibitors in EGFR-mutant non-small cell lung cancer (NSCLC); however, a multicenter cohort of patients with EGFR-mutant lung cancers treated with osimertinib and selpercatinib for RET fusion-mediated osimertinib resistance has not previously been published. PATIENTS AND METHODS Patients who received selpercatinib in combination with osimertinib on a prospective expanded access clinical trial (NCT03906331) and single-patient compassionate use programs across five countries were centrally analyzed. All patients had advanced EGFR-mutant NSCLC with a RET fusion detected from tissue or plasma following osimertinib therapy. Clinicopathologic and outcomes data were collected. RESULTS Fourteen patients with EGFR-mutant and RET fusion-positive lung cancers who experienced prior progression on osimertinib received osimertinib and selpercatinib. EGFR exon 19 deletions (±T790M, 86%) and non-KIF5B fusions (CCDC6-RET 50%, NCOA4-RET 36%) predominated. Osimertinib 80 mg daily and selpercatinib 80 mg twice daily were the most commonly administered dosages. The response rate, disease control rate, and median treatment duration were 50% [95% confidence interval (CI), 25%-75%, n = 12], 83% (95% CI, 55%-95%), and 7.9 months (range, 0.8-25+), respectively. Resistance was complex, involving EGFR on-target (EGFR C797S), RET on-target (RET G810S), and off-target (EML4-ALK/STRN-ALK, KRAS G12S, BRAF V600E) mechanisms; RET fusion loss; or polyclonal mechanisms. CONCLUSIONS For patients with EGFR-mutant NSCLC with an acquired RET fusion as a mechanism of EGFR inhibitor resistance, the addition of selpercatinib to osimertinib was feasible and safe and offered clinical benefit, supporting the prospective evaluation of this combination. See related commentary by Krebs and Popat, p. 2951.
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Affiliation(s)
- Julia Rotow
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jyoti D. Patel
- Department of Medicine, Northwestern University, Chicago, Illinois
| | | | - Helena Yu
- Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New Yorks
| | - Mark Awad
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | | | | | | | - Senthil Rajappa
- Basavatarakam Indo-American Cancer Hospital and Research Institute, Nandi Nagar, Banjara Hills, Hyderabad, Telangana, India
| | - Guilherme Harada
- Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New Yorks
| | - Sarah Clifford
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Alison Santucci
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Laura Silva
- Loxo Oncology at Lilly, Indianapolis, Indiana
| | | | - Geoffrey R. Oxnard
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Alexander Drilon
- Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New Yorks
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Nguyen J, Takebe N, Kummar S, Razak A, Chawla SP, George S, Patel SR, Keohan ML, Movva S, O'Sullivan Coyne G, Do K, Juwara L, Augustine B, Steinberg SM, Kuhlmann L, Ivy SP, Doroshow JH, Chen AP. Randomized Phase II Trial of Sunitinib or Cediranib in Alveolar Soft Part Sarcoma. Clin Cancer Res 2023; 29:1200-1208. [PMID: 36302173 PMCID: PMC10068440 DOI: 10.1158/1078-0432.ccr-22-2145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/26/2022] [Accepted: 10/24/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE Alveolar soft part sarcoma (ASPS) is a rare, highly vascular tumor with few treatment options. We designed a phase II randomized trial to determine the activity and tolerability of single-agent cediranib or sunitinib in patients with advanced metastatic ASPS. PATIENTS AND METHODS Patients 16 years of age and older were randomized to receive cediranib (30 mg) or sunitinib (37.5 mg) in 28-day cycles. Patients could cross over to the other treatment arm at disease progression. The primary endpoint was to measure the objective response rate (ORR) for each agent. Median progression-free survival (mPFS) for the two arms was also determined. RESULTS Twenty-nine of 34 enrolled patients were evaluable for response. One patient on each of the initial two treatment arms had a partial response (ORR: 6.7% and 7.1% for cediranib and sunitinib, respectively). Twenty-four patients had a best response of stable disease (86.7% and 78.6% for cediranib and sunitinib, respectively). There were no significant differences in mPFS for the two treatment arms. Clinical benefit (i.e., objective response or stable disease for a minimum of four or six cycles of therapy) on the first-line tyrosine kinase inhibitor (TKI) therapy did not predict benefit on the second-line TKI. Both drugs were well tolerated. As of August 2021, 1 patient (unevaluable for ORR) remains on study. CONCLUSIONS The study did not meet its endpoints for ORR. Although both TKIs provided clinical benefit, the outcomes may have been attenuated in patients who had progressed ≤6 months before enrollment, potentially accounting for the low response rates. See related commentary by Wilky and Maleddu, p. 1163.
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Affiliation(s)
- James Nguyen
- Division of Cancer Treatment and Diagnosis, NCI, Bethesda, Maryland
| | - Naoko Takebe
- Division of Cancer Treatment and Diagnosis, NCI, Bethesda, Maryland
| | - Shivaani Kummar
- Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon
| | | | | | - Suzanne George
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | | | | | - Sujana Movva
- Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | | | - Khanh Do
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Lamin Juwara
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research, Frederick, Maryland
| | - Brooke Augustine
- Division of Cancer Treatment and Diagnosis, NCI, Bethesda, Maryland
| | | | - Laura Kuhlmann
- Division of Cancer Treatment and Diagnosis, NCI, Bethesda, Maryland
| | - S. Percy Ivy
- Division of Cancer Treatment and Diagnosis, NCI, Bethesda, Maryland
| | - James H. Doroshow
- Division of Cancer Treatment and Diagnosis, NCI, Bethesda, Maryland
- Center for Cancer Research, NCI, Bethesda, Maryland
| | - Alice P. Chen
- Division of Cancer Treatment and Diagnosis, NCI, Bethesda, Maryland
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Li MC, Coumar MS, Lin SY, Lin YS, Huang GL, Chen CH, Lien TW, Wu YW, Chen YT, Chen CP, Huang YC, Yeh KC, Yang CM, Kalita B, Pan SL, Hsu TA, Yeh TK, Chen CT, Hsieh HP. Development of Furanopyrimidine-Based Orally Active Third-Generation EGFR Inhibitors for the Treatment of Non-Small Cell Lung Cancer. J Med Chem 2023; 66:2566-2588. [PMID: 36749735 PMCID: PMC9969398 DOI: 10.1021/acs.jmedchem.2c01434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The development of orally bioavailable, furanopyrimidine-based double-mutant (L858R/T790M) EGFR inhibitors is described. First, selectivity for mutant EGFR was accomplished by replacing the (S)-2-phenylglycinol moiety of 12 with either an ethanol or an alkyl substituent. Then, the cellular potency and physicochemical properties were optimized through insights from molecular modeling studies by implanting various solubilizing groups in phenyl rings A and B. Optimized lead 52 shows 8-fold selective inhibition of H1975 (EGFRL858R/T790M overexpressing) cancer cells over A431 (EGFRWT overexpressing) cancer cells; western blot analysis further confirmed EGFR mutant-selective target modulation inside the cancer cells by 52. Notably, 52 displayed in vivo antitumor effects in two different mouse xenograft models (BaF3 transfected with mutant EGFR and H1975 tumors) with TGI = 74.9 and 97.5% after oral administration (F = 27%), respectively. With an extraordinary kinome selectivity (S(10) score of 0.017), 52 undergoes detailed preclinical development.
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Affiliation(s)
- Mu-Chun Li
- Institute
of Biotechnology and Pharmaceutical Research, National Health Research Institutes, Miaoli County 350401, Taiwan, ROC
- Biomedical
Translation Research Center, Academia Sinica, Taipei City 115202, Taiwan, ROC
| | - Mohane Selvaraj Coumar
- Department
of Bioinformatics, School of Life Sciences, Pondicherry University, Kalapet 605014, Pondicherry, India
| | - Shu-Yu Lin
- Institute
of Biotechnology and Pharmaceutical Research, National Health Research Institutes, Miaoli County 350401, Taiwan, ROC
| | - Yih-Shyan Lin
- Institute
of Biotechnology and Pharmaceutical Research, National Health Research Institutes, Miaoli County 350401, Taiwan, ROC
| | - Guan-Lin Huang
- Institute
of Biotechnology and Pharmaceutical Research, National Health Research Institutes, Miaoli County 350401, Taiwan, ROC
| | - Chun-Hwa Chen
- Institute
of Biotechnology and Pharmaceutical Research, National Health Research Institutes, Miaoli County 350401, Taiwan, ROC
| | - Tzu-Wen Lien
- Institute
of Biotechnology and Pharmaceutical Research, National Health Research Institutes, Miaoli County 350401, Taiwan, ROC
| | - Yi-Wen Wu
- Graduate
Institute of Cancer Biology and Drug Discovery, College of Medical
Science and Technology, Taipei Medical University, Taipei City 110301, Taiwan, ROC
| | - Yen-Ting Chen
- Institute
of Biotechnology and Pharmaceutical Research, National Health Research Institutes, Miaoli County 350401, Taiwan, ROC
| | - Ching-Ping Chen
- Institute
of Biotechnology and Pharmaceutical Research, National Health Research Institutes, Miaoli County 350401, Taiwan, ROC
| | - Yu-Chen Huang
- Institute
of Biotechnology and Pharmaceutical Research, National Health Research Institutes, Miaoli County 350401, Taiwan, ROC
| | - Kai-Chia Yeh
- Institute
of Biotechnology and Pharmaceutical Research, National Health Research Institutes, Miaoli County 350401, Taiwan, ROC
| | - Chen-Ming Yang
- Institute
of Biotechnology and Pharmaceutical Research, National Health Research Institutes, Miaoli County 350401, Taiwan, ROC
| | - Bikashita Kalita
- Department
of Bioinformatics, School of Life Sciences, Pondicherry University, Kalapet 605014, Pondicherry, India
| | - Shiow-Lin Pan
- Graduate
Institute of Cancer Biology and Drug Discovery, College of Medical
Science and Technology, Taipei Medical University, Taipei City 110301, Taiwan, ROC
- Ph.D.
Program in Drug Discovery and Development Industry, College of Pharmacy, Taipei Medical University, Taipei City 110301, Taiwan, ROC
| | - Tsu-An Hsu
- Institute
of Biotechnology and Pharmaceutical Research, National Health Research Institutes, Miaoli County 350401, Taiwan, ROC
| | - Teng-Kuang Yeh
- Institute
of Biotechnology and Pharmaceutical Research, National Health Research Institutes, Miaoli County 350401, Taiwan, ROC
| | - Chiung-Tong Chen
- Institute
of Biotechnology and Pharmaceutical Research, National Health Research Institutes, Miaoli County 350401, Taiwan, ROC
| | - Hsing-Pang Hsieh
- Institute
of Biotechnology and Pharmaceutical Research, National Health Research Institutes, Miaoli County 350401, Taiwan, ROC
- Biomedical
Translation Research Center, Academia Sinica, Taipei City 115202, Taiwan, ROC
- Department
of Chemistry, National Tsing Hua University, Hsinchu City 300044, Taiwan, ROC
- , . Phone: +886-37-206-166
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Wang ML, Jurczak W, Jerkeman M, Trotman J, Zinzani PL, Belada D, Boccomini C, Flinn IW, Giri P, Goy A, Hamlin PA, Hermine O, Hernández-Rivas JÁ, Hong X, Kim SJ, Lewis D, Mishima Y, Özcan M, Perini GF, Pocock C, Song Y, Spurgeon SE, Storring JM, Walewski J, Zhu J, Qin R, Henninger T, Deshpande S, Howes A, Le Gouill S, Dreyling M. Ibrutinib plus Bendamustine and Rituximab in Untreated Mantle-Cell Lymphoma. N Engl J Med 2022; 386:2482-2494. [PMID: 35657079 DOI: 10.1056/nejmoa2201817] [Citation(s) in RCA: 63] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Ibrutinib, a Bruton's tyrosine kinase inhibitor, may have clinical benefit when administered in combination with bendamustine and rituximab and followed by rituximab maintenance therapy in older patients with untreated mantle-cell lymphoma. METHODS We randomly assigned patients 65 years of age or older to receive ibrutinib (560 mg, administered orally once daily until disease progression or unacceptable toxic effects) or placebo, plus six cycles of bendamustine (90 mg per square meter of body-surface area) and rituximab (375 mg per square meter). Patients with an objective response (complete or partial response) received rituximab maintenance therapy, administered every 8 weeks for up to 12 additional doses. The primary end point was progression-free survival as assessed by the investigators. Overall survival and safety were also assessed. RESULTS Among 523 patients, 261 were randomly assigned to receive ibrutinib and 262 to receive placebo. At a median follow-up of 84.7 months, the median progression-free survival was 80.6 months in the ibrutinib group and 52.9 months in the placebo group (hazard ratio for disease progression or death, 0.75; 95% confidence interval, 0.59 to 0.96; P = 0.01). The percentage of patients with a complete response was 65.5% in the ibrutinib group and 57.6% in the placebo group (P = 0.06). Overall survival was similar in the two groups. The incidence of grade 3 or 4 adverse events during treatment was 81.5% in the ibrutinib group and 77.3% in the placebo group. CONCLUSIONS Ibrutinib treatment in combination with standard chemoimmunotherapy significantly prolonged progression-free survival. The safety profile of the combined therapy was consistent with the known profiles of the individual drugs. (Funded by Janssen Research and Development and Pharmacyclics; SHINE ClinicalTrials.gov number, NCT01776840.).
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Affiliation(s)
- Michael L Wang
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - Wojciech Jurczak
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - Mats Jerkeman
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - Judith Trotman
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - Pier L Zinzani
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - David Belada
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - Carola Boccomini
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - Ian W Flinn
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - Pratyush Giri
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - Andre Goy
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - Paul A Hamlin
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - Olivier Hermine
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - José-Ángel Hernández-Rivas
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - Xiaonan Hong
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - Seok Jin Kim
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - David Lewis
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - Yuko Mishima
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - Muhit Özcan
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - Guilherme F Perini
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - Christopher Pocock
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - Yuqin Song
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - Stephen E Spurgeon
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - John M Storring
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - Jan Walewski
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - Jun Zhu
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - Rui Qin
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - Todd Henninger
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - Sanjay Deshpande
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - Angela Howes
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - Steven Le Gouill
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
| | - Martin Dreyling
- From the University of Texas M.D. Anderson Cancer Center, Houston (M.L.W.); Maria Sklodowska-Curie National Research Institute of Oncology, Kraków (W.J.), and Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw (J.W.) - both in Poland; Skane University Hospital and Lund University, Lund, Sweden (M.J.); Concord Repatriation General Hospital, University of Sydney, Sydney (J.T.), and Royal Adelaide Hospital, Adelaide, SA (P.G.) - both in Australia; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna (P.L.Z.), and SC Ematologia, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin (C.B.) - both in Italy; the Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic (D.B.); Sarah Cannon Research Institute and Tennessee Oncology, Nashville (I.W.F.); John Theurer Cancer Center, Hackensack (A.G.), and Janssen Research and Development, Raritan (R.Q., T.H., S.D., A.H.) - both in New Jersey; Memorial Sloan Kettering Cancer Center, New York (P.A.H.); the Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris and Institut Imagine, Université de Paris, INSERM Unité Mixte de Recherche 1183 (O.H.), and Institut Curie Comprehensive Cancer Center (S.L.G.), Paris, and Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes (S.L.G.) - all in France; the Department of Hematology, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid (J.-Á.H.-R.); Fudan University Shanghai Cancer Center, Shanghai (X.H.), and Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing (Y.S., J.Z.) - both in China; the Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (S.J.K.); University Hospitals Plymouth NHS Trust, Plymouth (D.L.), and Kent and Canterbury Hospital, Canterbury (C.P.) - both in the United Kingdom; the Department of Hematology-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo (Y.M.); Ankara University School of Medicine, Ankara, Turkey (M.Ö.); Hospital Israelita Albert Einstein, São Paulo (G.F.P.); the Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland (S.E.S.); the Research Institute of the McGill University Health Centre, McGill University, Montreal (J.M.S.); and Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany (M.D.)
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35
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Chow LQM, Barlesi F, Bertino EM, van den Bent MJ, Wakelee HA, Wen PY, Chiu CH, Orlov S, Chiari R, Majem M, McKeage M, Yu CJ, Garrido P, Hurtado FK, Arratia PC, Song Y, Branle F, Shi M, Kim DW. ASCEND-7: Efficacy and Safety of Ceritinib Treatment in Patients with ALK-Positive Non-Small Cell Lung Cancer Metastatic to the Brain and/or Leptomeninges. Clin Cancer Res 2022; 28:2506-2516. [PMID: 35091443 DOI: 10.1158/1078-0432.ccr-21-1838] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/25/2021] [Accepted: 01/25/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE Central nervous system metastases are a prominent cause of morbidity and mortality in patients with ALK-positive (ALK+) non-small cell lung cancer (NSCLC). The phase II ASCEND-7 (NCT02336451) study was specifically designed to assess the efficacy and safety of the ALK inhibitor (ALKi) ceritinib in patients with ALK+ NSCLC metastatic to the brain and/or leptomeninges. PATIENTS AND METHODS Patients with active brain metastases were allocated to study arms 1 to 4 based on prior exposure to an ALKi and/or prior brain radiation (arm 1: prior radiotherapy/ALKi-pretreated; arm 2: no radiotherapy/ALKi-pretreated; arm 3: prior radiotherapy/ALKi-naïve; arm 4: no radiotherapy/ALKi-naïve). Arm 5 included patients with leptomeningeal carcinomatosis. Patients received ceritinib 750 mg once daily (fasted condition). Primary endpoint was investigator-assessed whole-body overall response rate (ORR) per RECIST v1.1. Secondary endpoints included disease control rate (DCR) and intracranial/extracranial responses. RESULTS Per investigator assessment, in arms 1 (n = 42), 2 (n = 40), 3 (n = 12), and 4 (n = 44), respectively: whole-body ORRs [95% confidence interval (CI)] were 35.7% (21.6-52.0), 30.0% (16.6-46.5), 50.0% (21.1-78.9), and 59.1% (43.2-73.7); whole-body DCR (95% CI): 66.7% (50.5-80.4), 82.5% (67.2-92.7), 66.7% (34.9-90.1), and 70.5% (54.8-83.2); intracranial ORRs (95% CI): 39.3% (21.5-59.4), 27.6% (12.7-47.2), 28.6% (3.7-71.0), and 51.5% (33.5-69.2). In arm 5 (n = 18), whole-body ORR was 16.7% (95% CI, 3.6-41.4) and DCR was 66.7% (95% CI, 41.0-86.7). Paired cerebrospinal fluid and plasma sampling revealed that ceritinib penetrated the human blood-brain barrier. CONCLUSIONS Ceritinib showed antitumor activity in patients with ALK+ NSCLC with active brain metastases and/or leptomeningeal disease, and could be considered in the management of intracranial disease. See related commentary by Murciano-Goroff et al., p. 2477.
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Affiliation(s)
- Laura Q M Chow
- University of Washington, Seattle, Washington and University of Texas at Austin, Dell Medical School, Department of Oncology, Austin, Texas
| | - Fabrice Barlesi
- Aix-Marseille University, CNRS, INSERM, CRCM, APHM, Marseille, France
| | - Erin M Bertino
- The Ohio State University Comprehensive Cancer Centre, Arthur G James Cancer Hospital and Richard J Solove Research Institute, Columbus, Ohio
| | - Martin J van den Bent
- Department of Neurology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | - Patrick Y Wen
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Chao-Hua Chiu
- Department of Chest Medicine, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan
| | - Sergey Orlov
- State Pavlov Medical University, St. Petersburg, Russia
| | - Rita Chiari
- Department of Oncology, AULSS6 Euganea, Padova, Italy
| | | | | | - Chong-Jen Yu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Pilar Garrido
- Department of Medical Oncology, Hospital Universitario Ramon Y Cajal, Madrid, Spain
| | | | | | - Yuanbo Song
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | | | - Michael Shi
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | - Dong-Wan Kim
- Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Republic of Korea
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36
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Kuter DJ, Efraim M, Mayer J, Trněný M, McDonald V, Bird R, Regenbogen T, Garg M, Kaplan Z, Tzvetkov N, Choi PY, Jansen AJG, Kostal M, Baker R, Gumulec J, Lee EJ, Cunningham I, Goncalves I, Warner M, Boccia R, Gernsheimer T, Ghanima W, Bandman O, Burns R, Neale A, Thomas D, Arora P, Zheng B, Cooper N. Rilzabrutinib, an Oral BTK Inhibitor, in Immune Thrombocytopenia. N Engl J Med 2022; 386:1421-1431. [PMID: 35417637 DOI: 10.1056/nejmoa2110297] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Rilzabrutinib, an oral, reversible covalent inhibitor of Bruton's tyrosine kinase, may increase platelet counts in patients with immune thrombocytopenia by means of dual mechanisms of action: decreased macrophage (Fcγ receptor)-mediated platelet destruction and reduced production of pathogenic autoantibodies. METHODS In an international, adaptive, open-label, dose-finding, phase 1-2 clinical trial, we evaluated rilzabrutinib therapy in previously treated patients with immune thrombocytopenia. We used intrapatient dose escalation of oral rilzabrutinib over a period of 24 weeks; the lowest starting dose was 200 mg once daily, with higher starting doses of 400 mg once daily, 300 mg twice daily, and 400 mg twice daily. The primary end points were safety and platelet response (defined as at least two consecutive platelet counts of ≥50×103 per cubic millimeter and an increase from baseline of ≥20×103 per cubic millimeter without the use of rescue medication). RESULTS Sixty patients were enrolled. At baseline, the median platelet count was 15×103 per cubic millimeter, the median duration of disease was 6.3 years, and patients had received a median of four different immune thrombocytopenia therapies previously. All the treatment-related adverse events were of grade 1 or 2 and transient. There were no treatment-related bleeding or thrombotic events of grade 2 or higher. At a median of 167.5 days (range, 4 to 293) of treatment, 24 of 60 patients (40%) overall and 18 of the 45 patients (40%) who had started rilzabrutinib treatment at the highest dose met the primary end point of platelet response. The median time to the first platelet count of at least 50×103 per cubic millimeter was 11.5 days. Among patients with a primary platelet response, the mean percentage of weeks with a platelet count of at least 50×103 per cubic millimeter was 65%. CONCLUSIONS Rilzabrutinib was active and associated with only low-level toxic effects at all dose levels. The dose of 400 mg twice daily was identified as the dose for further testing. Overall, rilzabrutinib showed a rapid and durable clinical activity that improved with length of treatment. (Funded by Sanofi; ClinicalTrials.gov number, NCT03395210; EudraCT number, 2017-004012-19.).
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Affiliation(s)
- David J Kuter
- From the Hematology Division, Massachusetts General Hospital, and Harvard Medical School - both in Boston (D.J.K.); the Multiprofile Hospital for Active Treatment Sveta Marina EAD, Varna (M.E.), and the Clinic of Hematology, University Multiprofile Hospital for Active Treatment "Dr. Georgi Stranski" EAD, Pleven (N.T.) - both in Bulgaria; the Department of Internal Medicine, Hematology, and Oncology, Masaryk University Hospital, Brno (J.M.), the First Department of Medicine and the Department of Hematology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague (M.T.), the Fourth Department of Internal Medicine and Hematology, Faculty of Medicine, University Hospital of Hradec Kralove, Hradec Kralove (M.K.), and the Department of Hemato-oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (J.G.) - all in the Czech Republic; Barts Health NHS Trust, the Royal London Hospital (V.M.), and the Department of Immunology and Inflammation, Imperial College London (N.C.), London, and Leicester Royal Infirmary, Leicester (M.G.) - all in the United Kingdom; Princess Alexandra Hospital, Woolloongabba, QLD (R. Bird), Monash Medical Centre, Clayton, VIC (Z.K.), Canberra Hospital, Garran, ACT (P.Y.C.), Perth Blood Institute, Murdoch University, Perth, WA (R. Baker), Concord Repatriation General Hospital, Concord, NSW (I.C.), and Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Parkville, VIC (I.G.) - all in Australia; MidMichigan Health, Midland, MI (T.R.); Erasmus MC-University Medical Center, Rotterdam, the Netherlands (A.J.G.J.); NewYork-Presbyterian Hospital and Weill Cornell Medical Center, New York (E.-J.L.); McGill University Health Centre, Montreal (M.W.); the Center for Cancer and Blood Disorders, Bethesda, MD (R. Boccia); the University of Washington Medical Center, Seattle (T.G.); Ostfold Hospital Foundation, Gralum, and the Institute of Clinical Medicine, University of Oslo, Oslo - both in Norway (W.G.); and Principia Biopharma (a Sanofi company), South San Francisco, CA (O.B., R. Burns, A.N., D.T., P.A., B.Z.)
| | - Merlin Efraim
- From the Hematology Division, Massachusetts General Hospital, and Harvard Medical School - both in Boston (D.J.K.); the Multiprofile Hospital for Active Treatment Sveta Marina EAD, Varna (M.E.), and the Clinic of Hematology, University Multiprofile Hospital for Active Treatment "Dr. Georgi Stranski" EAD, Pleven (N.T.) - both in Bulgaria; the Department of Internal Medicine, Hematology, and Oncology, Masaryk University Hospital, Brno (J.M.), the First Department of Medicine and the Department of Hematology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague (M.T.), the Fourth Department of Internal Medicine and Hematology, Faculty of Medicine, University Hospital of Hradec Kralove, Hradec Kralove (M.K.), and the Department of Hemato-oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (J.G.) - all in the Czech Republic; Barts Health NHS Trust, the Royal London Hospital (V.M.), and the Department of Immunology and Inflammation, Imperial College London (N.C.), London, and Leicester Royal Infirmary, Leicester (M.G.) - all in the United Kingdom; Princess Alexandra Hospital, Woolloongabba, QLD (R. Bird), Monash Medical Centre, Clayton, VIC (Z.K.), Canberra Hospital, Garran, ACT (P.Y.C.), Perth Blood Institute, Murdoch University, Perth, WA (R. Baker), Concord Repatriation General Hospital, Concord, NSW (I.C.), and Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Parkville, VIC (I.G.) - all in Australia; MidMichigan Health, Midland, MI (T.R.); Erasmus MC-University Medical Center, Rotterdam, the Netherlands (A.J.G.J.); NewYork-Presbyterian Hospital and Weill Cornell Medical Center, New York (E.-J.L.); McGill University Health Centre, Montreal (M.W.); the Center for Cancer and Blood Disorders, Bethesda, MD (R. Boccia); the University of Washington Medical Center, Seattle (T.G.); Ostfold Hospital Foundation, Gralum, and the Institute of Clinical Medicine, University of Oslo, Oslo - both in Norway (W.G.); and Principia Biopharma (a Sanofi company), South San Francisco, CA (O.B., R. Burns, A.N., D.T., P.A., B.Z.)
| | - Jiri Mayer
- From the Hematology Division, Massachusetts General Hospital, and Harvard Medical School - both in Boston (D.J.K.); the Multiprofile Hospital for Active Treatment Sveta Marina EAD, Varna (M.E.), and the Clinic of Hematology, University Multiprofile Hospital for Active Treatment "Dr. Georgi Stranski" EAD, Pleven (N.T.) - both in Bulgaria; the Department of Internal Medicine, Hematology, and Oncology, Masaryk University Hospital, Brno (J.M.), the First Department of Medicine and the Department of Hematology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague (M.T.), the Fourth Department of Internal Medicine and Hematology, Faculty of Medicine, University Hospital of Hradec Kralove, Hradec Kralove (M.K.), and the Department of Hemato-oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (J.G.) - all in the Czech Republic; Barts Health NHS Trust, the Royal London Hospital (V.M.), and the Department of Immunology and Inflammation, Imperial College London (N.C.), London, and Leicester Royal Infirmary, Leicester (M.G.) - all in the United Kingdom; Princess Alexandra Hospital, Woolloongabba, QLD (R. Bird), Monash Medical Centre, Clayton, VIC (Z.K.), Canberra Hospital, Garran, ACT (P.Y.C.), Perth Blood Institute, Murdoch University, Perth, WA (R. Baker), Concord Repatriation General Hospital, Concord, NSW (I.C.), and Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Parkville, VIC (I.G.) - all in Australia; MidMichigan Health, Midland, MI (T.R.); Erasmus MC-University Medical Center, Rotterdam, the Netherlands (A.J.G.J.); NewYork-Presbyterian Hospital and Weill Cornell Medical Center, New York (E.-J.L.); McGill University Health Centre, Montreal (M.W.); the Center for Cancer and Blood Disorders, Bethesda, MD (R. Boccia); the University of Washington Medical Center, Seattle (T.G.); Ostfold Hospital Foundation, Gralum, and the Institute of Clinical Medicine, University of Oslo, Oslo - both in Norway (W.G.); and Principia Biopharma (a Sanofi company), South San Francisco, CA (O.B., R. Burns, A.N., D.T., P.A., B.Z.)
| | - Marek Trněný
- From the Hematology Division, Massachusetts General Hospital, and Harvard Medical School - both in Boston (D.J.K.); the Multiprofile Hospital for Active Treatment Sveta Marina EAD, Varna (M.E.), and the Clinic of Hematology, University Multiprofile Hospital for Active Treatment "Dr. Georgi Stranski" EAD, Pleven (N.T.) - both in Bulgaria; the Department of Internal Medicine, Hematology, and Oncology, Masaryk University Hospital, Brno (J.M.), the First Department of Medicine and the Department of Hematology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague (M.T.), the Fourth Department of Internal Medicine and Hematology, Faculty of Medicine, University Hospital of Hradec Kralove, Hradec Kralove (M.K.), and the Department of Hemato-oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (J.G.) - all in the Czech Republic; Barts Health NHS Trust, the Royal London Hospital (V.M.), and the Department of Immunology and Inflammation, Imperial College London (N.C.), London, and Leicester Royal Infirmary, Leicester (M.G.) - all in the United Kingdom; Princess Alexandra Hospital, Woolloongabba, QLD (R. Bird), Monash Medical Centre, Clayton, VIC (Z.K.), Canberra Hospital, Garran, ACT (P.Y.C.), Perth Blood Institute, Murdoch University, Perth, WA (R. Baker), Concord Repatriation General Hospital, Concord, NSW (I.C.), and Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Parkville, VIC (I.G.) - all in Australia; MidMichigan Health, Midland, MI (T.R.); Erasmus MC-University Medical Center, Rotterdam, the Netherlands (A.J.G.J.); NewYork-Presbyterian Hospital and Weill Cornell Medical Center, New York (E.-J.L.); McGill University Health Centre, Montreal (M.W.); the Center for Cancer and Blood Disorders, Bethesda, MD (R. Boccia); the University of Washington Medical Center, Seattle (T.G.); Ostfold Hospital Foundation, Gralum, and the Institute of Clinical Medicine, University of Oslo, Oslo - both in Norway (W.G.); and Principia Biopharma (a Sanofi company), South San Francisco, CA (O.B., R. Burns, A.N., D.T., P.A., B.Z.)
| | - Vickie McDonald
- From the Hematology Division, Massachusetts General Hospital, and Harvard Medical School - both in Boston (D.J.K.); the Multiprofile Hospital for Active Treatment Sveta Marina EAD, Varna (M.E.), and the Clinic of Hematology, University Multiprofile Hospital for Active Treatment "Dr. Georgi Stranski" EAD, Pleven (N.T.) - both in Bulgaria; the Department of Internal Medicine, Hematology, and Oncology, Masaryk University Hospital, Brno (J.M.), the First Department of Medicine and the Department of Hematology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague (M.T.), the Fourth Department of Internal Medicine and Hematology, Faculty of Medicine, University Hospital of Hradec Kralove, Hradec Kralove (M.K.), and the Department of Hemato-oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (J.G.) - all in the Czech Republic; Barts Health NHS Trust, the Royal London Hospital (V.M.), and the Department of Immunology and Inflammation, Imperial College London (N.C.), London, and Leicester Royal Infirmary, Leicester (M.G.) - all in the United Kingdom; Princess Alexandra Hospital, Woolloongabba, QLD (R. Bird), Monash Medical Centre, Clayton, VIC (Z.K.), Canberra Hospital, Garran, ACT (P.Y.C.), Perth Blood Institute, Murdoch University, Perth, WA (R. Baker), Concord Repatriation General Hospital, Concord, NSW (I.C.), and Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Parkville, VIC (I.G.) - all in Australia; MidMichigan Health, Midland, MI (T.R.); Erasmus MC-University Medical Center, Rotterdam, the Netherlands (A.J.G.J.); NewYork-Presbyterian Hospital and Weill Cornell Medical Center, New York (E.-J.L.); McGill University Health Centre, Montreal (M.W.); the Center for Cancer and Blood Disorders, Bethesda, MD (R. Boccia); the University of Washington Medical Center, Seattle (T.G.); Ostfold Hospital Foundation, Gralum, and the Institute of Clinical Medicine, University of Oslo, Oslo - both in Norway (W.G.); and Principia Biopharma (a Sanofi company), South San Francisco, CA (O.B., R. Burns, A.N., D.T., P.A., B.Z.)
| | - Robert Bird
- From the Hematology Division, Massachusetts General Hospital, and Harvard Medical School - both in Boston (D.J.K.); the Multiprofile Hospital for Active Treatment Sveta Marina EAD, Varna (M.E.), and the Clinic of Hematology, University Multiprofile Hospital for Active Treatment "Dr. Georgi Stranski" EAD, Pleven (N.T.) - both in Bulgaria; the Department of Internal Medicine, Hematology, and Oncology, Masaryk University Hospital, Brno (J.M.), the First Department of Medicine and the Department of Hematology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague (M.T.), the Fourth Department of Internal Medicine and Hematology, Faculty of Medicine, University Hospital of Hradec Kralove, Hradec Kralove (M.K.), and the Department of Hemato-oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (J.G.) - all in the Czech Republic; Barts Health NHS Trust, the Royal London Hospital (V.M.), and the Department of Immunology and Inflammation, Imperial College London (N.C.), London, and Leicester Royal Infirmary, Leicester (M.G.) - all in the United Kingdom; Princess Alexandra Hospital, Woolloongabba, QLD (R. Bird), Monash Medical Centre, Clayton, VIC (Z.K.), Canberra Hospital, Garran, ACT (P.Y.C.), Perth Blood Institute, Murdoch University, Perth, WA (R. Baker), Concord Repatriation General Hospital, Concord, NSW (I.C.), and Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Parkville, VIC (I.G.) - all in Australia; MidMichigan Health, Midland, MI (T.R.); Erasmus MC-University Medical Center, Rotterdam, the Netherlands (A.J.G.J.); NewYork-Presbyterian Hospital and Weill Cornell Medical Center, New York (E.-J.L.); McGill University Health Centre, Montreal (M.W.); the Center for Cancer and Blood Disorders, Bethesda, MD (R. Boccia); the University of Washington Medical Center, Seattle (T.G.); Ostfold Hospital Foundation, Gralum, and the Institute of Clinical Medicine, University of Oslo, Oslo - both in Norway (W.G.); and Principia Biopharma (a Sanofi company), South San Francisco, CA (O.B., R. Burns, A.N., D.T., P.A., B.Z.)
| | - Thomas Regenbogen
- From the Hematology Division, Massachusetts General Hospital, and Harvard Medical School - both in Boston (D.J.K.); the Multiprofile Hospital for Active Treatment Sveta Marina EAD, Varna (M.E.), and the Clinic of Hematology, University Multiprofile Hospital for Active Treatment "Dr. Georgi Stranski" EAD, Pleven (N.T.) - both in Bulgaria; the Department of Internal Medicine, Hematology, and Oncology, Masaryk University Hospital, Brno (J.M.), the First Department of Medicine and the Department of Hematology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague (M.T.), the Fourth Department of Internal Medicine and Hematology, Faculty of Medicine, University Hospital of Hradec Kralove, Hradec Kralove (M.K.), and the Department of Hemato-oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (J.G.) - all in the Czech Republic; Barts Health NHS Trust, the Royal London Hospital (V.M.), and the Department of Immunology and Inflammation, Imperial College London (N.C.), London, and Leicester Royal Infirmary, Leicester (M.G.) - all in the United Kingdom; Princess Alexandra Hospital, Woolloongabba, QLD (R. Bird), Monash Medical Centre, Clayton, VIC (Z.K.), Canberra Hospital, Garran, ACT (P.Y.C.), Perth Blood Institute, Murdoch University, Perth, WA (R. Baker), Concord Repatriation General Hospital, Concord, NSW (I.C.), and Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Parkville, VIC (I.G.) - all in Australia; MidMichigan Health, Midland, MI (T.R.); Erasmus MC-University Medical Center, Rotterdam, the Netherlands (A.J.G.J.); NewYork-Presbyterian Hospital and Weill Cornell Medical Center, New York (E.-J.L.); McGill University Health Centre, Montreal (M.W.); the Center for Cancer and Blood Disorders, Bethesda, MD (R. Boccia); the University of Washington Medical Center, Seattle (T.G.); Ostfold Hospital Foundation, Gralum, and the Institute of Clinical Medicine, University of Oslo, Oslo - both in Norway (W.G.); and Principia Biopharma (a Sanofi company), South San Francisco, CA (O.B., R. Burns, A.N., D.T., P.A., B.Z.)
| | - Mamta Garg
- From the Hematology Division, Massachusetts General Hospital, and Harvard Medical School - both in Boston (D.J.K.); the Multiprofile Hospital for Active Treatment Sveta Marina EAD, Varna (M.E.), and the Clinic of Hematology, University Multiprofile Hospital for Active Treatment "Dr. Georgi Stranski" EAD, Pleven (N.T.) - both in Bulgaria; the Department of Internal Medicine, Hematology, and Oncology, Masaryk University Hospital, Brno (J.M.), the First Department of Medicine and the Department of Hematology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague (M.T.), the Fourth Department of Internal Medicine and Hematology, Faculty of Medicine, University Hospital of Hradec Kralove, Hradec Kralove (M.K.), and the Department of Hemato-oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (J.G.) - all in the Czech Republic; Barts Health NHS Trust, the Royal London Hospital (V.M.), and the Department of Immunology and Inflammation, Imperial College London (N.C.), London, and Leicester Royal Infirmary, Leicester (M.G.) - all in the United Kingdom; Princess Alexandra Hospital, Woolloongabba, QLD (R. Bird), Monash Medical Centre, Clayton, VIC (Z.K.), Canberra Hospital, Garran, ACT (P.Y.C.), Perth Blood Institute, Murdoch University, Perth, WA (R. Baker), Concord Repatriation General Hospital, Concord, NSW (I.C.), and Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Parkville, VIC (I.G.) - all in Australia; MidMichigan Health, Midland, MI (T.R.); Erasmus MC-University Medical Center, Rotterdam, the Netherlands (A.J.G.J.); NewYork-Presbyterian Hospital and Weill Cornell Medical Center, New York (E.-J.L.); McGill University Health Centre, Montreal (M.W.); the Center for Cancer and Blood Disorders, Bethesda, MD (R. Boccia); the University of Washington Medical Center, Seattle (T.G.); Ostfold Hospital Foundation, Gralum, and the Institute of Clinical Medicine, University of Oslo, Oslo - both in Norway (W.G.); and Principia Biopharma (a Sanofi company), South San Francisco, CA (O.B., R. Burns, A.N., D.T., P.A., B.Z.)
| | - Zane Kaplan
- From the Hematology Division, Massachusetts General Hospital, and Harvard Medical School - both in Boston (D.J.K.); the Multiprofile Hospital for Active Treatment Sveta Marina EAD, Varna (M.E.), and the Clinic of Hematology, University Multiprofile Hospital for Active Treatment "Dr. Georgi Stranski" EAD, Pleven (N.T.) - both in Bulgaria; the Department of Internal Medicine, Hematology, and Oncology, Masaryk University Hospital, Brno (J.M.), the First Department of Medicine and the Department of Hematology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague (M.T.), the Fourth Department of Internal Medicine and Hematology, Faculty of Medicine, University Hospital of Hradec Kralove, Hradec Kralove (M.K.), and the Department of Hemato-oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (J.G.) - all in the Czech Republic; Barts Health NHS Trust, the Royal London Hospital (V.M.), and the Department of Immunology and Inflammation, Imperial College London (N.C.), London, and Leicester Royal Infirmary, Leicester (M.G.) - all in the United Kingdom; Princess Alexandra Hospital, Woolloongabba, QLD (R. Bird), Monash Medical Centre, Clayton, VIC (Z.K.), Canberra Hospital, Garran, ACT (P.Y.C.), Perth Blood Institute, Murdoch University, Perth, WA (R. Baker), Concord Repatriation General Hospital, Concord, NSW (I.C.), and Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Parkville, VIC (I.G.) - all in Australia; MidMichigan Health, Midland, MI (T.R.); Erasmus MC-University Medical Center, Rotterdam, the Netherlands (A.J.G.J.); NewYork-Presbyterian Hospital and Weill Cornell Medical Center, New York (E.-J.L.); McGill University Health Centre, Montreal (M.W.); the Center for Cancer and Blood Disorders, Bethesda, MD (R. Boccia); the University of Washington Medical Center, Seattle (T.G.); Ostfold Hospital Foundation, Gralum, and the Institute of Clinical Medicine, University of Oslo, Oslo - both in Norway (W.G.); and Principia Biopharma (a Sanofi company), South San Francisco, CA (O.B., R. Burns, A.N., D.T., P.A., B.Z.)
| | - Nikolay Tzvetkov
- From the Hematology Division, Massachusetts General Hospital, and Harvard Medical School - both in Boston (D.J.K.); the Multiprofile Hospital for Active Treatment Sveta Marina EAD, Varna (M.E.), and the Clinic of Hematology, University Multiprofile Hospital for Active Treatment "Dr. Georgi Stranski" EAD, Pleven (N.T.) - both in Bulgaria; the Department of Internal Medicine, Hematology, and Oncology, Masaryk University Hospital, Brno (J.M.), the First Department of Medicine and the Department of Hematology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague (M.T.), the Fourth Department of Internal Medicine and Hematology, Faculty of Medicine, University Hospital of Hradec Kralove, Hradec Kralove (M.K.), and the Department of Hemato-oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (J.G.) - all in the Czech Republic; Barts Health NHS Trust, the Royal London Hospital (V.M.), and the Department of Immunology and Inflammation, Imperial College London (N.C.), London, and Leicester Royal Infirmary, Leicester (M.G.) - all in the United Kingdom; Princess Alexandra Hospital, Woolloongabba, QLD (R. Bird), Monash Medical Centre, Clayton, VIC (Z.K.), Canberra Hospital, Garran, ACT (P.Y.C.), Perth Blood Institute, Murdoch University, Perth, WA (R. Baker), Concord Repatriation General Hospital, Concord, NSW (I.C.), and Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Parkville, VIC (I.G.) - all in Australia; MidMichigan Health, Midland, MI (T.R.); Erasmus MC-University Medical Center, Rotterdam, the Netherlands (A.J.G.J.); NewYork-Presbyterian Hospital and Weill Cornell Medical Center, New York (E.-J.L.); McGill University Health Centre, Montreal (M.W.); the Center for Cancer and Blood Disorders, Bethesda, MD (R. Boccia); the University of Washington Medical Center, Seattle (T.G.); Ostfold Hospital Foundation, Gralum, and the Institute of Clinical Medicine, University of Oslo, Oslo - both in Norway (W.G.); and Principia Biopharma (a Sanofi company), South San Francisco, CA (O.B., R. Burns, A.N., D.T., P.A., B.Z.)
| | - Philip Y Choi
- From the Hematology Division, Massachusetts General Hospital, and Harvard Medical School - both in Boston (D.J.K.); the Multiprofile Hospital for Active Treatment Sveta Marina EAD, Varna (M.E.), and the Clinic of Hematology, University Multiprofile Hospital for Active Treatment "Dr. Georgi Stranski" EAD, Pleven (N.T.) - both in Bulgaria; the Department of Internal Medicine, Hematology, and Oncology, Masaryk University Hospital, Brno (J.M.), the First Department of Medicine and the Department of Hematology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague (M.T.), the Fourth Department of Internal Medicine and Hematology, Faculty of Medicine, University Hospital of Hradec Kralove, Hradec Kralove (M.K.), and the Department of Hemato-oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (J.G.) - all in the Czech Republic; Barts Health NHS Trust, the Royal London Hospital (V.M.), and the Department of Immunology and Inflammation, Imperial College London (N.C.), London, and Leicester Royal Infirmary, Leicester (M.G.) - all in the United Kingdom; Princess Alexandra Hospital, Woolloongabba, QLD (R. Bird), Monash Medical Centre, Clayton, VIC (Z.K.), Canberra Hospital, Garran, ACT (P.Y.C.), Perth Blood Institute, Murdoch University, Perth, WA (R. Baker), Concord Repatriation General Hospital, Concord, NSW (I.C.), and Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Parkville, VIC (I.G.) - all in Australia; MidMichigan Health, Midland, MI (T.R.); Erasmus MC-University Medical Center, Rotterdam, the Netherlands (A.J.G.J.); NewYork-Presbyterian Hospital and Weill Cornell Medical Center, New York (E.-J.L.); McGill University Health Centre, Montreal (M.W.); the Center for Cancer and Blood Disorders, Bethesda, MD (R. Boccia); the University of Washington Medical Center, Seattle (T.G.); Ostfold Hospital Foundation, Gralum, and the Institute of Clinical Medicine, University of Oslo, Oslo - both in Norway (W.G.); and Principia Biopharma (a Sanofi company), South San Francisco, CA (O.B., R. Burns, A.N., D.T., P.A., B.Z.)
| | - A J Gerard Jansen
- From the Hematology Division, Massachusetts General Hospital, and Harvard Medical School - both in Boston (D.J.K.); the Multiprofile Hospital for Active Treatment Sveta Marina EAD, Varna (M.E.), and the Clinic of Hematology, University Multiprofile Hospital for Active Treatment "Dr. Georgi Stranski" EAD, Pleven (N.T.) - both in Bulgaria; the Department of Internal Medicine, Hematology, and Oncology, Masaryk University Hospital, Brno (J.M.), the First Department of Medicine and the Department of Hematology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague (M.T.), the Fourth Department of Internal Medicine and Hematology, Faculty of Medicine, University Hospital of Hradec Kralove, Hradec Kralove (M.K.), and the Department of Hemato-oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (J.G.) - all in the Czech Republic; Barts Health NHS Trust, the Royal London Hospital (V.M.), and the Department of Immunology and Inflammation, Imperial College London (N.C.), London, and Leicester Royal Infirmary, Leicester (M.G.) - all in the United Kingdom; Princess Alexandra Hospital, Woolloongabba, QLD (R. Bird), Monash Medical Centre, Clayton, VIC (Z.K.), Canberra Hospital, Garran, ACT (P.Y.C.), Perth Blood Institute, Murdoch University, Perth, WA (R. Baker), Concord Repatriation General Hospital, Concord, NSW (I.C.), and Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Parkville, VIC (I.G.) - all in Australia; MidMichigan Health, Midland, MI (T.R.); Erasmus MC-University Medical Center, Rotterdam, the Netherlands (A.J.G.J.); NewYork-Presbyterian Hospital and Weill Cornell Medical Center, New York (E.-J.L.); McGill University Health Centre, Montreal (M.W.); the Center for Cancer and Blood Disorders, Bethesda, MD (R. Boccia); the University of Washington Medical Center, Seattle (T.G.); Ostfold Hospital Foundation, Gralum, and the Institute of Clinical Medicine, University of Oslo, Oslo - both in Norway (W.G.); and Principia Biopharma (a Sanofi company), South San Francisco, CA (O.B., R. Burns, A.N., D.T., P.A., B.Z.)
| | - Milan Kostal
- From the Hematology Division, Massachusetts General Hospital, and Harvard Medical School - both in Boston (D.J.K.); the Multiprofile Hospital for Active Treatment Sveta Marina EAD, Varna (M.E.), and the Clinic of Hematology, University Multiprofile Hospital for Active Treatment "Dr. Georgi Stranski" EAD, Pleven (N.T.) - both in Bulgaria; the Department of Internal Medicine, Hematology, and Oncology, Masaryk University Hospital, Brno (J.M.), the First Department of Medicine and the Department of Hematology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague (M.T.), the Fourth Department of Internal Medicine and Hematology, Faculty of Medicine, University Hospital of Hradec Kralove, Hradec Kralove (M.K.), and the Department of Hemato-oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (J.G.) - all in the Czech Republic; Barts Health NHS Trust, the Royal London Hospital (V.M.), and the Department of Immunology and Inflammation, Imperial College London (N.C.), London, and Leicester Royal Infirmary, Leicester (M.G.) - all in the United Kingdom; Princess Alexandra Hospital, Woolloongabba, QLD (R. Bird), Monash Medical Centre, Clayton, VIC (Z.K.), Canberra Hospital, Garran, ACT (P.Y.C.), Perth Blood Institute, Murdoch University, Perth, WA (R. Baker), Concord Repatriation General Hospital, Concord, NSW (I.C.), and Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Parkville, VIC (I.G.) - all in Australia; MidMichigan Health, Midland, MI (T.R.); Erasmus MC-University Medical Center, Rotterdam, the Netherlands (A.J.G.J.); NewYork-Presbyterian Hospital and Weill Cornell Medical Center, New York (E.-J.L.); McGill University Health Centre, Montreal (M.W.); the Center for Cancer and Blood Disorders, Bethesda, MD (R. Boccia); the University of Washington Medical Center, Seattle (T.G.); Ostfold Hospital Foundation, Gralum, and the Institute of Clinical Medicine, University of Oslo, Oslo - both in Norway (W.G.); and Principia Biopharma (a Sanofi company), South San Francisco, CA (O.B., R. Burns, A.N., D.T., P.A., B.Z.)
| | - Ross Baker
- From the Hematology Division, Massachusetts General Hospital, and Harvard Medical School - both in Boston (D.J.K.); the Multiprofile Hospital for Active Treatment Sveta Marina EAD, Varna (M.E.), and the Clinic of Hematology, University Multiprofile Hospital for Active Treatment "Dr. Georgi Stranski" EAD, Pleven (N.T.) - both in Bulgaria; the Department of Internal Medicine, Hematology, and Oncology, Masaryk University Hospital, Brno (J.M.), the First Department of Medicine and the Department of Hematology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague (M.T.), the Fourth Department of Internal Medicine and Hematology, Faculty of Medicine, University Hospital of Hradec Kralove, Hradec Kralove (M.K.), and the Department of Hemato-oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (J.G.) - all in the Czech Republic; Barts Health NHS Trust, the Royal London Hospital (V.M.), and the Department of Immunology and Inflammation, Imperial College London (N.C.), London, and Leicester Royal Infirmary, Leicester (M.G.) - all in the United Kingdom; Princess Alexandra Hospital, Woolloongabba, QLD (R. Bird), Monash Medical Centre, Clayton, VIC (Z.K.), Canberra Hospital, Garran, ACT (P.Y.C.), Perth Blood Institute, Murdoch University, Perth, WA (R. Baker), Concord Repatriation General Hospital, Concord, NSW (I.C.), and Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Parkville, VIC (I.G.) - all in Australia; MidMichigan Health, Midland, MI (T.R.); Erasmus MC-University Medical Center, Rotterdam, the Netherlands (A.J.G.J.); NewYork-Presbyterian Hospital and Weill Cornell Medical Center, New York (E.-J.L.); McGill University Health Centre, Montreal (M.W.); the Center for Cancer and Blood Disorders, Bethesda, MD (R. Boccia); the University of Washington Medical Center, Seattle (T.G.); Ostfold Hospital Foundation, Gralum, and the Institute of Clinical Medicine, University of Oslo, Oslo - both in Norway (W.G.); and Principia Biopharma (a Sanofi company), South San Francisco, CA (O.B., R. Burns, A.N., D.T., P.A., B.Z.)
| | - Jaromir Gumulec
- From the Hematology Division, Massachusetts General Hospital, and Harvard Medical School - both in Boston (D.J.K.); the Multiprofile Hospital for Active Treatment Sveta Marina EAD, Varna (M.E.), and the Clinic of Hematology, University Multiprofile Hospital for Active Treatment "Dr. Georgi Stranski" EAD, Pleven (N.T.) - both in Bulgaria; the Department of Internal Medicine, Hematology, and Oncology, Masaryk University Hospital, Brno (J.M.), the First Department of Medicine and the Department of Hematology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague (M.T.), the Fourth Department of Internal Medicine and Hematology, Faculty of Medicine, University Hospital of Hradec Kralove, Hradec Kralove (M.K.), and the Department of Hemato-oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (J.G.) - all in the Czech Republic; Barts Health NHS Trust, the Royal London Hospital (V.M.), and the Department of Immunology and Inflammation, Imperial College London (N.C.), London, and Leicester Royal Infirmary, Leicester (M.G.) - all in the United Kingdom; Princess Alexandra Hospital, Woolloongabba, QLD (R. Bird), Monash Medical Centre, Clayton, VIC (Z.K.), Canberra Hospital, Garran, ACT (P.Y.C.), Perth Blood Institute, Murdoch University, Perth, WA (R. Baker), Concord Repatriation General Hospital, Concord, NSW (I.C.), and Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Parkville, VIC (I.G.) - all in Australia; MidMichigan Health, Midland, MI (T.R.); Erasmus MC-University Medical Center, Rotterdam, the Netherlands (A.J.G.J.); NewYork-Presbyterian Hospital and Weill Cornell Medical Center, New York (E.-J.L.); McGill University Health Centre, Montreal (M.W.); the Center for Cancer and Blood Disorders, Bethesda, MD (R. Boccia); the University of Washington Medical Center, Seattle (T.G.); Ostfold Hospital Foundation, Gralum, and the Institute of Clinical Medicine, University of Oslo, Oslo - both in Norway (W.G.); and Principia Biopharma (a Sanofi company), South San Francisco, CA (O.B., R. Burns, A.N., D.T., P.A., B.Z.)
| | - Eun-Ju Lee
- From the Hematology Division, Massachusetts General Hospital, and Harvard Medical School - both in Boston (D.J.K.); the Multiprofile Hospital for Active Treatment Sveta Marina EAD, Varna (M.E.), and the Clinic of Hematology, University Multiprofile Hospital for Active Treatment "Dr. Georgi Stranski" EAD, Pleven (N.T.) - both in Bulgaria; the Department of Internal Medicine, Hematology, and Oncology, Masaryk University Hospital, Brno (J.M.), the First Department of Medicine and the Department of Hematology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague (M.T.), the Fourth Department of Internal Medicine and Hematology, Faculty of Medicine, University Hospital of Hradec Kralove, Hradec Kralove (M.K.), and the Department of Hemato-oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (J.G.) - all in the Czech Republic; Barts Health NHS Trust, the Royal London Hospital (V.M.), and the Department of Immunology and Inflammation, Imperial College London (N.C.), London, and Leicester Royal Infirmary, Leicester (M.G.) - all in the United Kingdom; Princess Alexandra Hospital, Woolloongabba, QLD (R. Bird), Monash Medical Centre, Clayton, VIC (Z.K.), Canberra Hospital, Garran, ACT (P.Y.C.), Perth Blood Institute, Murdoch University, Perth, WA (R. Baker), Concord Repatriation General Hospital, Concord, NSW (I.C.), and Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Parkville, VIC (I.G.) - all in Australia; MidMichigan Health, Midland, MI (T.R.); Erasmus MC-University Medical Center, Rotterdam, the Netherlands (A.J.G.J.); NewYork-Presbyterian Hospital and Weill Cornell Medical Center, New York (E.-J.L.); McGill University Health Centre, Montreal (M.W.); the Center for Cancer and Blood Disorders, Bethesda, MD (R. Boccia); the University of Washington Medical Center, Seattle (T.G.); Ostfold Hospital Foundation, Gralum, and the Institute of Clinical Medicine, University of Oslo, Oslo - both in Norway (W.G.); and Principia Biopharma (a Sanofi company), South San Francisco, CA (O.B., R. Burns, A.N., D.T., P.A., B.Z.)
| | - Ilona Cunningham
- From the Hematology Division, Massachusetts General Hospital, and Harvard Medical School - both in Boston (D.J.K.); the Multiprofile Hospital for Active Treatment Sveta Marina EAD, Varna (M.E.), and the Clinic of Hematology, University Multiprofile Hospital for Active Treatment "Dr. Georgi Stranski" EAD, Pleven (N.T.) - both in Bulgaria; the Department of Internal Medicine, Hematology, and Oncology, Masaryk University Hospital, Brno (J.M.), the First Department of Medicine and the Department of Hematology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague (M.T.), the Fourth Department of Internal Medicine and Hematology, Faculty of Medicine, University Hospital of Hradec Kralove, Hradec Kralove (M.K.), and the Department of Hemato-oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (J.G.) - all in the Czech Republic; Barts Health NHS Trust, the Royal London Hospital (V.M.), and the Department of Immunology and Inflammation, Imperial College London (N.C.), London, and Leicester Royal Infirmary, Leicester (M.G.) - all in the United Kingdom; Princess Alexandra Hospital, Woolloongabba, QLD (R. Bird), Monash Medical Centre, Clayton, VIC (Z.K.), Canberra Hospital, Garran, ACT (P.Y.C.), Perth Blood Institute, Murdoch University, Perth, WA (R. Baker), Concord Repatriation General Hospital, Concord, NSW (I.C.), and Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Parkville, VIC (I.G.) - all in Australia; MidMichigan Health, Midland, MI (T.R.); Erasmus MC-University Medical Center, Rotterdam, the Netherlands (A.J.G.J.); NewYork-Presbyterian Hospital and Weill Cornell Medical Center, New York (E.-J.L.); McGill University Health Centre, Montreal (M.W.); the Center for Cancer and Blood Disorders, Bethesda, MD (R. Boccia); the University of Washington Medical Center, Seattle (T.G.); Ostfold Hospital Foundation, Gralum, and the Institute of Clinical Medicine, University of Oslo, Oslo - both in Norway (W.G.); and Principia Biopharma (a Sanofi company), South San Francisco, CA (O.B., R. Burns, A.N., D.T., P.A., B.Z.)
| | - Isaac Goncalves
- From the Hematology Division, Massachusetts General Hospital, and Harvard Medical School - both in Boston (D.J.K.); the Multiprofile Hospital for Active Treatment Sveta Marina EAD, Varna (M.E.), and the Clinic of Hematology, University Multiprofile Hospital for Active Treatment "Dr. Georgi Stranski" EAD, Pleven (N.T.) - both in Bulgaria; the Department of Internal Medicine, Hematology, and Oncology, Masaryk University Hospital, Brno (J.M.), the First Department of Medicine and the Department of Hematology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague (M.T.), the Fourth Department of Internal Medicine and Hematology, Faculty of Medicine, University Hospital of Hradec Kralove, Hradec Kralove (M.K.), and the Department of Hemato-oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (J.G.) - all in the Czech Republic; Barts Health NHS Trust, the Royal London Hospital (V.M.), and the Department of Immunology and Inflammation, Imperial College London (N.C.), London, and Leicester Royal Infirmary, Leicester (M.G.) - all in the United Kingdom; Princess Alexandra Hospital, Woolloongabba, QLD (R. Bird), Monash Medical Centre, Clayton, VIC (Z.K.), Canberra Hospital, Garran, ACT (P.Y.C.), Perth Blood Institute, Murdoch University, Perth, WA (R. Baker), Concord Repatriation General Hospital, Concord, NSW (I.C.), and Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Parkville, VIC (I.G.) - all in Australia; MidMichigan Health, Midland, MI (T.R.); Erasmus MC-University Medical Center, Rotterdam, the Netherlands (A.J.G.J.); NewYork-Presbyterian Hospital and Weill Cornell Medical Center, New York (E.-J.L.); McGill University Health Centre, Montreal (M.W.); the Center for Cancer and Blood Disorders, Bethesda, MD (R. Boccia); the University of Washington Medical Center, Seattle (T.G.); Ostfold Hospital Foundation, Gralum, and the Institute of Clinical Medicine, University of Oslo, Oslo - both in Norway (W.G.); and Principia Biopharma (a Sanofi company), South San Francisco, CA (O.B., R. Burns, A.N., D.T., P.A., B.Z.)
| | - Margaret Warner
- From the Hematology Division, Massachusetts General Hospital, and Harvard Medical School - both in Boston (D.J.K.); the Multiprofile Hospital for Active Treatment Sveta Marina EAD, Varna (M.E.), and the Clinic of Hematology, University Multiprofile Hospital for Active Treatment "Dr. Georgi Stranski" EAD, Pleven (N.T.) - both in Bulgaria; the Department of Internal Medicine, Hematology, and Oncology, Masaryk University Hospital, Brno (J.M.), the First Department of Medicine and the Department of Hematology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague (M.T.), the Fourth Department of Internal Medicine and Hematology, Faculty of Medicine, University Hospital of Hradec Kralove, Hradec Kralove (M.K.), and the Department of Hemato-oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (J.G.) - all in the Czech Republic; Barts Health NHS Trust, the Royal London Hospital (V.M.), and the Department of Immunology and Inflammation, Imperial College London (N.C.), London, and Leicester Royal Infirmary, Leicester (M.G.) - all in the United Kingdom; Princess Alexandra Hospital, Woolloongabba, QLD (R. Bird), Monash Medical Centre, Clayton, VIC (Z.K.), Canberra Hospital, Garran, ACT (P.Y.C.), Perth Blood Institute, Murdoch University, Perth, WA (R. Baker), Concord Repatriation General Hospital, Concord, NSW (I.C.), and Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Parkville, VIC (I.G.) - all in Australia; MidMichigan Health, Midland, MI (T.R.); Erasmus MC-University Medical Center, Rotterdam, the Netherlands (A.J.G.J.); NewYork-Presbyterian Hospital and Weill Cornell Medical Center, New York (E.-J.L.); McGill University Health Centre, Montreal (M.W.); the Center for Cancer and Blood Disorders, Bethesda, MD (R. Boccia); the University of Washington Medical Center, Seattle (T.G.); Ostfold Hospital Foundation, Gralum, and the Institute of Clinical Medicine, University of Oslo, Oslo - both in Norway (W.G.); and Principia Biopharma (a Sanofi company), South San Francisco, CA (O.B., R. Burns, A.N., D.T., P.A., B.Z.)
| | - Ralph Boccia
- From the Hematology Division, Massachusetts General Hospital, and Harvard Medical School - both in Boston (D.J.K.); the Multiprofile Hospital for Active Treatment Sveta Marina EAD, Varna (M.E.), and the Clinic of Hematology, University Multiprofile Hospital for Active Treatment "Dr. Georgi Stranski" EAD, Pleven (N.T.) - both in Bulgaria; the Department of Internal Medicine, Hematology, and Oncology, Masaryk University Hospital, Brno (J.M.), the First Department of Medicine and the Department of Hematology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague (M.T.), the Fourth Department of Internal Medicine and Hematology, Faculty of Medicine, University Hospital of Hradec Kralove, Hradec Kralove (M.K.), and the Department of Hemato-oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (J.G.) - all in the Czech Republic; Barts Health NHS Trust, the Royal London Hospital (V.M.), and the Department of Immunology and Inflammation, Imperial College London (N.C.), London, and Leicester Royal Infirmary, Leicester (M.G.) - all in the United Kingdom; Princess Alexandra Hospital, Woolloongabba, QLD (R. Bird), Monash Medical Centre, Clayton, VIC (Z.K.), Canberra Hospital, Garran, ACT (P.Y.C.), Perth Blood Institute, Murdoch University, Perth, WA (R. Baker), Concord Repatriation General Hospital, Concord, NSW (I.C.), and Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Parkville, VIC (I.G.) - all in Australia; MidMichigan Health, Midland, MI (T.R.); Erasmus MC-University Medical Center, Rotterdam, the Netherlands (A.J.G.J.); NewYork-Presbyterian Hospital and Weill Cornell Medical Center, New York (E.-J.L.); McGill University Health Centre, Montreal (M.W.); the Center for Cancer and Blood Disorders, Bethesda, MD (R. Boccia); the University of Washington Medical Center, Seattle (T.G.); Ostfold Hospital Foundation, Gralum, and the Institute of Clinical Medicine, University of Oslo, Oslo - both in Norway (W.G.); and Principia Biopharma (a Sanofi company), South San Francisco, CA (O.B., R. Burns, A.N., D.T., P.A., B.Z.)
| | - Terry Gernsheimer
- From the Hematology Division, Massachusetts General Hospital, and Harvard Medical School - both in Boston (D.J.K.); the Multiprofile Hospital for Active Treatment Sveta Marina EAD, Varna (M.E.), and the Clinic of Hematology, University Multiprofile Hospital for Active Treatment "Dr. Georgi Stranski" EAD, Pleven (N.T.) - both in Bulgaria; the Department of Internal Medicine, Hematology, and Oncology, Masaryk University Hospital, Brno (J.M.), the First Department of Medicine and the Department of Hematology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague (M.T.), the Fourth Department of Internal Medicine and Hematology, Faculty of Medicine, University Hospital of Hradec Kralove, Hradec Kralove (M.K.), and the Department of Hemato-oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (J.G.) - all in the Czech Republic; Barts Health NHS Trust, the Royal London Hospital (V.M.), and the Department of Immunology and Inflammation, Imperial College London (N.C.), London, and Leicester Royal Infirmary, Leicester (M.G.) - all in the United Kingdom; Princess Alexandra Hospital, Woolloongabba, QLD (R. Bird), Monash Medical Centre, Clayton, VIC (Z.K.), Canberra Hospital, Garran, ACT (P.Y.C.), Perth Blood Institute, Murdoch University, Perth, WA (R. Baker), Concord Repatriation General Hospital, Concord, NSW (I.C.), and Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Parkville, VIC (I.G.) - all in Australia; MidMichigan Health, Midland, MI (T.R.); Erasmus MC-University Medical Center, Rotterdam, the Netherlands (A.J.G.J.); NewYork-Presbyterian Hospital and Weill Cornell Medical Center, New York (E.-J.L.); McGill University Health Centre, Montreal (M.W.); the Center for Cancer and Blood Disorders, Bethesda, MD (R. Boccia); the University of Washington Medical Center, Seattle (T.G.); Ostfold Hospital Foundation, Gralum, and the Institute of Clinical Medicine, University of Oslo, Oslo - both in Norway (W.G.); and Principia Biopharma (a Sanofi company), South San Francisco, CA (O.B., R. Burns, A.N., D.T., P.A., B.Z.)
| | - Waleed Ghanima
- From the Hematology Division, Massachusetts General Hospital, and Harvard Medical School - both in Boston (D.J.K.); the Multiprofile Hospital for Active Treatment Sveta Marina EAD, Varna (M.E.), and the Clinic of Hematology, University Multiprofile Hospital for Active Treatment "Dr. Georgi Stranski" EAD, Pleven (N.T.) - both in Bulgaria; the Department of Internal Medicine, Hematology, and Oncology, Masaryk University Hospital, Brno (J.M.), the First Department of Medicine and the Department of Hematology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague (M.T.), the Fourth Department of Internal Medicine and Hematology, Faculty of Medicine, University Hospital of Hradec Kralove, Hradec Kralove (M.K.), and the Department of Hemato-oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (J.G.) - all in the Czech Republic; Barts Health NHS Trust, the Royal London Hospital (V.M.), and the Department of Immunology and Inflammation, Imperial College London (N.C.), London, and Leicester Royal Infirmary, Leicester (M.G.) - all in the United Kingdom; Princess Alexandra Hospital, Woolloongabba, QLD (R. Bird), Monash Medical Centre, Clayton, VIC (Z.K.), Canberra Hospital, Garran, ACT (P.Y.C.), Perth Blood Institute, Murdoch University, Perth, WA (R. Baker), Concord Repatriation General Hospital, Concord, NSW (I.C.), and Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Parkville, VIC (I.G.) - all in Australia; MidMichigan Health, Midland, MI (T.R.); Erasmus MC-University Medical Center, Rotterdam, the Netherlands (A.J.G.J.); NewYork-Presbyterian Hospital and Weill Cornell Medical Center, New York (E.-J.L.); McGill University Health Centre, Montreal (M.W.); the Center for Cancer and Blood Disorders, Bethesda, MD (R. Boccia); the University of Washington Medical Center, Seattle (T.G.); Ostfold Hospital Foundation, Gralum, and the Institute of Clinical Medicine, University of Oslo, Oslo - both in Norway (W.G.); and Principia Biopharma (a Sanofi company), South San Francisco, CA (O.B., R. Burns, A.N., D.T., P.A., B.Z.)
| | - Olga Bandman
- From the Hematology Division, Massachusetts General Hospital, and Harvard Medical School - both in Boston (D.J.K.); the Multiprofile Hospital for Active Treatment Sveta Marina EAD, Varna (M.E.), and the Clinic of Hematology, University Multiprofile Hospital for Active Treatment "Dr. Georgi Stranski" EAD, Pleven (N.T.) - both in Bulgaria; the Department of Internal Medicine, Hematology, and Oncology, Masaryk University Hospital, Brno (J.M.), the First Department of Medicine and the Department of Hematology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague (M.T.), the Fourth Department of Internal Medicine and Hematology, Faculty of Medicine, University Hospital of Hradec Kralove, Hradec Kralove (M.K.), and the Department of Hemato-oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (J.G.) - all in the Czech Republic; Barts Health NHS Trust, the Royal London Hospital (V.M.), and the Department of Immunology and Inflammation, Imperial College London (N.C.), London, and Leicester Royal Infirmary, Leicester (M.G.) - all in the United Kingdom; Princess Alexandra Hospital, Woolloongabba, QLD (R. Bird), Monash Medical Centre, Clayton, VIC (Z.K.), Canberra Hospital, Garran, ACT (P.Y.C.), Perth Blood Institute, Murdoch University, Perth, WA (R. Baker), Concord Repatriation General Hospital, Concord, NSW (I.C.), and Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Parkville, VIC (I.G.) - all in Australia; MidMichigan Health, Midland, MI (T.R.); Erasmus MC-University Medical Center, Rotterdam, the Netherlands (A.J.G.J.); NewYork-Presbyterian Hospital and Weill Cornell Medical Center, New York (E.-J.L.); McGill University Health Centre, Montreal (M.W.); the Center for Cancer and Blood Disorders, Bethesda, MD (R. Boccia); the University of Washington Medical Center, Seattle (T.G.); Ostfold Hospital Foundation, Gralum, and the Institute of Clinical Medicine, University of Oslo, Oslo - both in Norway (W.G.); and Principia Biopharma (a Sanofi company), South San Francisco, CA (O.B., R. Burns, A.N., D.T., P.A., B.Z.)
| | - Regan Burns
- From the Hematology Division, Massachusetts General Hospital, and Harvard Medical School - both in Boston (D.J.K.); the Multiprofile Hospital for Active Treatment Sveta Marina EAD, Varna (M.E.), and the Clinic of Hematology, University Multiprofile Hospital for Active Treatment "Dr. Georgi Stranski" EAD, Pleven (N.T.) - both in Bulgaria; the Department of Internal Medicine, Hematology, and Oncology, Masaryk University Hospital, Brno (J.M.), the First Department of Medicine and the Department of Hematology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague (M.T.), the Fourth Department of Internal Medicine and Hematology, Faculty of Medicine, University Hospital of Hradec Kralove, Hradec Kralove (M.K.), and the Department of Hemato-oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (J.G.) - all in the Czech Republic; Barts Health NHS Trust, the Royal London Hospital (V.M.), and the Department of Immunology and Inflammation, Imperial College London (N.C.), London, and Leicester Royal Infirmary, Leicester (M.G.) - all in the United Kingdom; Princess Alexandra Hospital, Woolloongabba, QLD (R. Bird), Monash Medical Centre, Clayton, VIC (Z.K.), Canberra Hospital, Garran, ACT (P.Y.C.), Perth Blood Institute, Murdoch University, Perth, WA (R. Baker), Concord Repatriation General Hospital, Concord, NSW (I.C.), and Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Parkville, VIC (I.G.) - all in Australia; MidMichigan Health, Midland, MI (T.R.); Erasmus MC-University Medical Center, Rotterdam, the Netherlands (A.J.G.J.); NewYork-Presbyterian Hospital and Weill Cornell Medical Center, New York (E.-J.L.); McGill University Health Centre, Montreal (M.W.); the Center for Cancer and Blood Disorders, Bethesda, MD (R. Boccia); the University of Washington Medical Center, Seattle (T.G.); Ostfold Hospital Foundation, Gralum, and the Institute of Clinical Medicine, University of Oslo, Oslo - both in Norway (W.G.); and Principia Biopharma (a Sanofi company), South San Francisco, CA (O.B., R. Burns, A.N., D.T., P.A., B.Z.)
| | - Ann Neale
- From the Hematology Division, Massachusetts General Hospital, and Harvard Medical School - both in Boston (D.J.K.); the Multiprofile Hospital for Active Treatment Sveta Marina EAD, Varna (M.E.), and the Clinic of Hematology, University Multiprofile Hospital for Active Treatment "Dr. Georgi Stranski" EAD, Pleven (N.T.) - both in Bulgaria; the Department of Internal Medicine, Hematology, and Oncology, Masaryk University Hospital, Brno (J.M.), the First Department of Medicine and the Department of Hematology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague (M.T.), the Fourth Department of Internal Medicine and Hematology, Faculty of Medicine, University Hospital of Hradec Kralove, Hradec Kralove (M.K.), and the Department of Hemato-oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (J.G.) - all in the Czech Republic; Barts Health NHS Trust, the Royal London Hospital (V.M.), and the Department of Immunology and Inflammation, Imperial College London (N.C.), London, and Leicester Royal Infirmary, Leicester (M.G.) - all in the United Kingdom; Princess Alexandra Hospital, Woolloongabba, QLD (R. Bird), Monash Medical Centre, Clayton, VIC (Z.K.), Canberra Hospital, Garran, ACT (P.Y.C.), Perth Blood Institute, Murdoch University, Perth, WA (R. Baker), Concord Repatriation General Hospital, Concord, NSW (I.C.), and Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Parkville, VIC (I.G.) - all in Australia; MidMichigan Health, Midland, MI (T.R.); Erasmus MC-University Medical Center, Rotterdam, the Netherlands (A.J.G.J.); NewYork-Presbyterian Hospital and Weill Cornell Medical Center, New York (E.-J.L.); McGill University Health Centre, Montreal (M.W.); the Center for Cancer and Blood Disorders, Bethesda, MD (R. Boccia); the University of Washington Medical Center, Seattle (T.G.); Ostfold Hospital Foundation, Gralum, and the Institute of Clinical Medicine, University of Oslo, Oslo - both in Norway (W.G.); and Principia Biopharma (a Sanofi company), South San Francisco, CA (O.B., R. Burns, A.N., D.T., P.A., B.Z.)
| | - Dolca Thomas
- From the Hematology Division, Massachusetts General Hospital, and Harvard Medical School - both in Boston (D.J.K.); the Multiprofile Hospital for Active Treatment Sveta Marina EAD, Varna (M.E.), and the Clinic of Hematology, University Multiprofile Hospital for Active Treatment "Dr. Georgi Stranski" EAD, Pleven (N.T.) - both in Bulgaria; the Department of Internal Medicine, Hematology, and Oncology, Masaryk University Hospital, Brno (J.M.), the First Department of Medicine and the Department of Hematology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague (M.T.), the Fourth Department of Internal Medicine and Hematology, Faculty of Medicine, University Hospital of Hradec Kralove, Hradec Kralove (M.K.), and the Department of Hemato-oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (J.G.) - all in the Czech Republic; Barts Health NHS Trust, the Royal London Hospital (V.M.), and the Department of Immunology and Inflammation, Imperial College London (N.C.), London, and Leicester Royal Infirmary, Leicester (M.G.) - all in the United Kingdom; Princess Alexandra Hospital, Woolloongabba, QLD (R. Bird), Monash Medical Centre, Clayton, VIC (Z.K.), Canberra Hospital, Garran, ACT (P.Y.C.), Perth Blood Institute, Murdoch University, Perth, WA (R. Baker), Concord Repatriation General Hospital, Concord, NSW (I.C.), and Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Parkville, VIC (I.G.) - all in Australia; MidMichigan Health, Midland, MI (T.R.); Erasmus MC-University Medical Center, Rotterdam, the Netherlands (A.J.G.J.); NewYork-Presbyterian Hospital and Weill Cornell Medical Center, New York (E.-J.L.); McGill University Health Centre, Montreal (M.W.); the Center for Cancer and Blood Disorders, Bethesda, MD (R. Boccia); the University of Washington Medical Center, Seattle (T.G.); Ostfold Hospital Foundation, Gralum, and the Institute of Clinical Medicine, University of Oslo, Oslo - both in Norway (W.G.); and Principia Biopharma (a Sanofi company), South San Francisco, CA (O.B., R. Burns, A.N., D.T., P.A., B.Z.)
| | - Puneet Arora
- From the Hematology Division, Massachusetts General Hospital, and Harvard Medical School - both in Boston (D.J.K.); the Multiprofile Hospital for Active Treatment Sveta Marina EAD, Varna (M.E.), and the Clinic of Hematology, University Multiprofile Hospital for Active Treatment "Dr. Georgi Stranski" EAD, Pleven (N.T.) - both in Bulgaria; the Department of Internal Medicine, Hematology, and Oncology, Masaryk University Hospital, Brno (J.M.), the First Department of Medicine and the Department of Hematology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague (M.T.), the Fourth Department of Internal Medicine and Hematology, Faculty of Medicine, University Hospital of Hradec Kralove, Hradec Kralove (M.K.), and the Department of Hemato-oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (J.G.) - all in the Czech Republic; Barts Health NHS Trust, the Royal London Hospital (V.M.), and the Department of Immunology and Inflammation, Imperial College London (N.C.), London, and Leicester Royal Infirmary, Leicester (M.G.) - all in the United Kingdom; Princess Alexandra Hospital, Woolloongabba, QLD (R. Bird), Monash Medical Centre, Clayton, VIC (Z.K.), Canberra Hospital, Garran, ACT (P.Y.C.), Perth Blood Institute, Murdoch University, Perth, WA (R. Baker), Concord Repatriation General Hospital, Concord, NSW (I.C.), and Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Parkville, VIC (I.G.) - all in Australia; MidMichigan Health, Midland, MI (T.R.); Erasmus MC-University Medical Center, Rotterdam, the Netherlands (A.J.G.J.); NewYork-Presbyterian Hospital and Weill Cornell Medical Center, New York (E.-J.L.); McGill University Health Centre, Montreal (M.W.); the Center for Cancer and Blood Disorders, Bethesda, MD (R. Boccia); the University of Washington Medical Center, Seattle (T.G.); Ostfold Hospital Foundation, Gralum, and the Institute of Clinical Medicine, University of Oslo, Oslo - both in Norway (W.G.); and Principia Biopharma (a Sanofi company), South San Francisco, CA (O.B., R. Burns, A.N., D.T., P.A., B.Z.)
| | - Beiyao Zheng
- From the Hematology Division, Massachusetts General Hospital, and Harvard Medical School - both in Boston (D.J.K.); the Multiprofile Hospital for Active Treatment Sveta Marina EAD, Varna (M.E.), and the Clinic of Hematology, University Multiprofile Hospital for Active Treatment "Dr. Georgi Stranski" EAD, Pleven (N.T.) - both in Bulgaria; the Department of Internal Medicine, Hematology, and Oncology, Masaryk University Hospital, Brno (J.M.), the First Department of Medicine and the Department of Hematology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague (M.T.), the Fourth Department of Internal Medicine and Hematology, Faculty of Medicine, University Hospital of Hradec Kralove, Hradec Kralove (M.K.), and the Department of Hemato-oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (J.G.) - all in the Czech Republic; Barts Health NHS Trust, the Royal London Hospital (V.M.), and the Department of Immunology and Inflammation, Imperial College London (N.C.), London, and Leicester Royal Infirmary, Leicester (M.G.) - all in the United Kingdom; Princess Alexandra Hospital, Woolloongabba, QLD (R. Bird), Monash Medical Centre, Clayton, VIC (Z.K.), Canberra Hospital, Garran, ACT (P.Y.C.), Perth Blood Institute, Murdoch University, Perth, WA (R. Baker), Concord Repatriation General Hospital, Concord, NSW (I.C.), and Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Parkville, VIC (I.G.) - all in Australia; MidMichigan Health, Midland, MI (T.R.); Erasmus MC-University Medical Center, Rotterdam, the Netherlands (A.J.G.J.); NewYork-Presbyterian Hospital and Weill Cornell Medical Center, New York (E.-J.L.); McGill University Health Centre, Montreal (M.W.); the Center for Cancer and Blood Disorders, Bethesda, MD (R. Boccia); the University of Washington Medical Center, Seattle (T.G.); Ostfold Hospital Foundation, Gralum, and the Institute of Clinical Medicine, University of Oslo, Oslo - both in Norway (W.G.); and Principia Biopharma (a Sanofi company), South San Francisco, CA (O.B., R. Burns, A.N., D.T., P.A., B.Z.)
| | - Nichola Cooper
- From the Hematology Division, Massachusetts General Hospital, and Harvard Medical School - both in Boston (D.J.K.); the Multiprofile Hospital for Active Treatment Sveta Marina EAD, Varna (M.E.), and the Clinic of Hematology, University Multiprofile Hospital for Active Treatment "Dr. Georgi Stranski" EAD, Pleven (N.T.) - both in Bulgaria; the Department of Internal Medicine, Hematology, and Oncology, Masaryk University Hospital, Brno (J.M.), the First Department of Medicine and the Department of Hematology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague (M.T.), the Fourth Department of Internal Medicine and Hematology, Faculty of Medicine, University Hospital of Hradec Kralove, Hradec Kralove (M.K.), and the Department of Hemato-oncology, University Hospital Ostrava, and the Faculty of Medicine, University of Ostrava, Ostrava (J.G.) - all in the Czech Republic; Barts Health NHS Trust, the Royal London Hospital (V.M.), and the Department of Immunology and Inflammation, Imperial College London (N.C.), London, and Leicester Royal Infirmary, Leicester (M.G.) - all in the United Kingdom; Princess Alexandra Hospital, Woolloongabba, QLD (R. Bird), Monash Medical Centre, Clayton, VIC (Z.K.), Canberra Hospital, Garran, ACT (P.Y.C.), Perth Blood Institute, Murdoch University, Perth, WA (R. Baker), Concord Repatriation General Hospital, Concord, NSW (I.C.), and Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Parkville, VIC (I.G.) - all in Australia; MidMichigan Health, Midland, MI (T.R.); Erasmus MC-University Medical Center, Rotterdam, the Netherlands (A.J.G.J.); NewYork-Presbyterian Hospital and Weill Cornell Medical Center, New York (E.-J.L.); McGill University Health Centre, Montreal (M.W.); the Center for Cancer and Blood Disorders, Bethesda, MD (R. Boccia); the University of Washington Medical Center, Seattle (T.G.); Ostfold Hospital Foundation, Gralum, and the Institute of Clinical Medicine, University of Oslo, Oslo - both in Norway (W.G.); and Principia Biopharma (a Sanofi company), South San Francisco, CA (O.B., R. Burns, A.N., D.T., P.A., B.Z.)
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Duan S, Li C, Gao Y, Meng P, Ji S, Xu Y, Mao Y, Wang H, Tian J. The tyrosine kinase inhibitor LPM4870108 impairs learning and memory and induces transcriptomic and gene‑specific DNA methylation changes in rats. Arch Toxicol 2022; 96:845-857. [PMID: 35098321 DOI: 10.1007/s00204-022-03226-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/12/2022] [Indexed: 11/02/2022]
Abstract
Tyrosine kinase inhibitors (TKIs), which have been developed and approved for cancer treatment in the last few years, are involved in synaptic plasticity of learning and memory. Epigenetic modifications also play crucial roles in the process of learning and memory, but its relationship with TKI-induced learning and memory impairment has not been investigated. We hypothesized that LPM4870108, an effective anti-cancer Trk inhibitor, might affect the learning and memory via epigenetic modifications. In this study, rats were orally administered with LPM4870108 (0, 1.25, 2.5, or 5.0 mg/kg) twice daily for 28 days, after which animals were subjected to a Morris water maze test. LPM4870108 exposure caused learning and memory impairments in this test in a dose-dependent manner and reduced the spine densities. Whole-genome transcriptomic analysis revealed significant differences in the patterns of hippocampal gene expression in LPM4870108-treated rats. These transcriptomic data were combined with next-generation bisulfite sequencing analysis, after which RT-PCR and pyrosequencing were conducted, revealing epigenetic alterations associated with genes (Snx8, Fgfr1, Dusp4, Vav2, and Satb2) known to regulate learning and memory. Increased mRNA and protein expression levels of hippocampal Dnmt1 and Dnmt3a were also observed in these rats. Overall, these data suggest that gene-specific alterations in patterns of DNA methylation can potentially contribute to the incidence of learning and memory deficits associated with exposure to LPM4870108.
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Affiliation(s)
- Sijin Duan
- School of Pharmacy, Key Laboratory of Molecular Pharmacology and Drug Evaluation (Yantai University), Ministry of Education, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, Yantai University, Yantai, 264005, People's Republic of China
| | - Chunmei Li
- School of Pharmacy, Key Laboratory of Molecular Pharmacology and Drug Evaluation (Yantai University), Ministry of Education, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, Yantai University, Yantai, 264005, People's Republic of China
| | - Yonglin Gao
- State Key Laboratory of Long-Acting Targeting Drug Delivery Technologies (Luye Pharma Group Ltd.), Yantai, 264003, People's Republic of China
- School of Life Science, Yantai University, Yantai, 264005, People's Republic of China
| | - Ping Meng
- School of Pharmacy, Key Laboratory of Molecular Pharmacology and Drug Evaluation (Yantai University), Ministry of Education, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, Yantai University, Yantai, 264005, People's Republic of China
| | - Shengmin Ji
- School of Pharmacy, Key Laboratory of Molecular Pharmacology and Drug Evaluation (Yantai University), Ministry of Education, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, Yantai University, Yantai, 264005, People's Republic of China
| | - Yangyang Xu
- School of Pharmacy, Key Laboratory of Molecular Pharmacology and Drug Evaluation (Yantai University), Ministry of Education, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, Yantai University, Yantai, 264005, People's Republic of China
| | - Yutong Mao
- School of Pharmacy, Key Laboratory of Molecular Pharmacology and Drug Evaluation (Yantai University), Ministry of Education, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, Yantai University, Yantai, 264005, People's Republic of China
| | - Hongbo Wang
- School of Pharmacy, Key Laboratory of Molecular Pharmacology and Drug Evaluation (Yantai University), Ministry of Education, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, Yantai University, Yantai, 264005, People's Republic of China
| | - Jingwei Tian
- School of Pharmacy, Key Laboratory of Molecular Pharmacology and Drug Evaluation (Yantai University), Ministry of Education, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, Yantai University, Yantai, 264005, People's Republic of China.
- State Key Laboratory of Long-Acting Targeting Drug Delivery Technologies (Luye Pharma Group Ltd.), Yantai, 264003, People's Republic of China.
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Albiges L, Schmidinger M, Taguieva-Pioger N, Perol D, Grünwald V, Guemas E. CaboPoint: a phase II study of cabozantinib as second-line treatment in patients with metastatic renal cell carcinoma. Future Oncol 2022; 18:915-926. [PMID: 34911359 DOI: 10.2217/fon-2021-1006] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Cabozantinib is an inhibitor of multiple tyrosine kinases, including AXL, MET and VEGF receptors. Here, we describe the rationale and design for the phase II CaboPoint trial (ClinicalTrials.gov identifier: NCT03945773), which will evaluate the efficacy and safety of cabozantinib as a second-line treatment in patients with unresectable, locally advanced or metastatic renal cell carcinoma whose disease has progressed despite checkpoint inhibitor therapy. Patients will be recruited into two cohorts: prior ipilimumab plus nivolumab (cohort A) or prior checkpoint inhibitor-VEGF-targeted therapy (cohort B). All patients will receive once-daily oral cabozantinib 60 mg for up to 18 months. The primary end point is objective response rate. Secondary end points include overall survival, progression-free survival and safety.
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Affiliation(s)
- Laurence Albiges
- Medical Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif 94805, France
| | - Manuela Schmidinger
- Department of Medicine I, Department of Urology, Medical University of Vienna, Vienna 1090, Austria
| | | | - David Perol
- Department of Clinical Research, Centre Léon Bérard, Lyon 69008, France
| | - Viktor Grünwald
- Essen University Hospital, West German Cancer Center, Clinic for Medical Oncology & Clinic for Urology, Essen 45147, Germany
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Li L, Zhang H, Xie Y, Su N, Su S, Zhang X, Cen W. The Efficacy and Safety of Anlotinib Alone and in Combination with Other Drugs in Advanced Lung Cancer: A Retrospective Cohort Study. Comput Math Methods Med 2022; 2022:1475871. [PMID: 35251294 PMCID: PMC8896944 DOI: 10.1155/2022/1475871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/10/2022] [Accepted: 01/26/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Lung cancer is a disease associated with high levels of morbidity and mortality, with approximately 2.1 million new cases every year. Anlotinib is a new small-molecule multitarget tyrosine kinase inhibitor independently developed in China that can inhibit the formation of tumor blood vessels and has a therapeutic effect on various cancers. However, the application of anlotinib in lung cancer needs further investigation. METHODS We collected the progress notes of 43 patients with advanced lung cancer treated at the Oncology Department of Guangzhou Chest Hospital from March 2019 to March 2021. Additionally, we assessed the differences between drug combination therapy and single-drug therapy among patients treated with anlotinib. RESULTS Patients in both the anlotinib-combination and anlotinib-monotherapy groups experienced remission; however, the overall disease control rate in the anlotinib-combination group was higher than that in the anlotinib-monotherapy group. Reexamination via computed tomography showed that patients in the anlotinib-combination group had better recovery than those in the anlotinib-monotherapy group. Although the overall incidence of adverse reactions in the anlotinib-combination group was higher than that in the monotherapy group, most of the adverse reactions were I-II levels and improved after symptomatic treatment. CONCLUSION Anlotinib combined with other therapies is better than anlotinib alone for the management of patients with advanced lung cancer.
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Affiliation(s)
- Lei Li
- Department of Oncology, Guangzhou Chest Hospital, Guangzhou, China
| | - Hui Zhang
- Department of Oncology, Guangzhou Chest Hospital, Guangzhou, China
| | - Yalin Xie
- Department of Oncology, Guangzhou Chest Hospital, Guangzhou, China
| | - Ning Su
- Department of Oncology, Guangzhou Chest Hospital, Guangzhou, China
| | - Shan Su
- Department of Oncology, Guangzhou Chest Hospital, Guangzhou, China
| | - Xianlan Zhang
- Department of Oncology, Guangzhou Chest Hospital, Guangzhou, China
| | - Wenchang Cen
- Department of Oncology, Guangzhou Chest Hospital, Guangzhou, China
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Brose MS, Panaseykin Y, Konda B, de la Fouchardiere C, Hughes BGM, Gianoukakis AG, Joo Park Y, Romanov I, Krzyzanowska MK, Leboulleux S, Binder TA, Dutcus C, Xie R, Taylor MH. A Randomized Study of Lenvatinib 18 mg vs 24 mg in Patients With Radioiodine-Refractory Differentiated Thyroid Cancer. J Clin Endocrinol Metab 2022; 107:776-787. [PMID: 34664662 PMCID: PMC8852210 DOI: 10.1210/clinem/dgab731] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Lenvatinib is a multikinase inhibitor approved to treat radioiodine-refractory differentiated thyroid cancer (RR-DTC) at a starting dose of 24 mg/day. This study explored, in a double-blinded fashion, whether a starting dose of 18 mg/day would provide comparable efficacy with reduced toxicity. METHODS Patients with RR-DTC were randomized to lenvatinib 24 mg/day or 18 mg/day. The primary efficacy endpoint was objective response rate as of week 24 (ORRwk24); the odds ratio noninferiority margin was 0.4. The primary safety endpoint was frequency of grade ≥3 treatment-emergent adverse events (TEAEs) as of week 24. Tumors were assessed using RECIST v1.1. TEAEs were monitored and recorded. RESULTS The ORRwk24 was 57.3% (95% CI 46.1, 68.5) in the lenvatinib 24-mg arm and 40.3% (95% CI 29.3, 51.2) in the lenvatinib 18-mg arm, with an odds ratio (18/24 mg) of 0.50 (95% CI 0.26, 0.96). As of week 24, the rates of TEAEs grade ≥3 were 61.3% in the lenvatinib 24-mg arm and 57.1% in the lenvatinib 18-mg arm, a difference of -4.2% (95% CI -19.8, 11.4). CONCLUSION A starting dose of lenvatinib 18 mg/day did not demonstrate noninferiority compared to a starting dose of 24 mg/day as assessed by ORRwk24 in patients with RR-DTC. The results represent a clinically meaningful difference in ORRwk24. The safety profile was comparable, with no clinically relevant difference between arms. These results support the continued use of the approved starting dose of lenvatinib 24 mg/day in patients with RR-DTC and adjusting the dose as necessary.
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Affiliation(s)
- Marcia S Brose
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Jefferson Health, Philadelphia, PA, USA
- Correspondence: Marcia S. Brose, MD, PhD, Sidney Kimmel Cancer Center, Jefferson Torresdale Hospital, 10800 Knights Rd, 3rd floor, Philadelphia, PA 19114, USA. E-mail: .; Previous Affiliation: M.S.B., Department of Otorhinolaryngology, Head and Neck Surgery, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA.; Current Affiliation: M.S.B., Department of Medical Oncology, Sidney Kimmel Cancer Center, Jefferson Health, Philadelphia, PA, USA
| | - Yury Panaseykin
- A. Tsyb Medical Radiological Research Center, Branch of the NMRС of Radiology, Obninsk, Russian Federation
| | - Bhavana Konda
- Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | | | - Brett G M Hughes
- Department of Cancer Care Services, Royal Brisbane and Women’s Hospital, University of Queensland, Queensland, Australia
| | - Andrew G Gianoukakis
- The Lundquist Institute at Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles/Torrance, CA, USA
| | - Young Joo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ilia Romanov
- Department of Head and Neck Tumors, N.N. Blokhin Russian Cancer Research Center, Moscow, Russian Federation
| | - Monika K Krzyzanowska
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Sophie Leboulleux
- Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy, Villejuif, France
| | - Terri A Binder
- Oncology Clinical Research, Eisai Inc., Woodcliff Lake, NJ, USA
| | - Corina Dutcus
- Oncology Clinical Research, Eisai Inc., Woodcliff Lake, NJ, USA
| | - Ran Xie
- Biostatistics, Eisai Inc., Woodcliff Lake, NJ, USA
| | - Matthew H Taylor
- Earle A. Chiles Research Institute, Providence Cancer Institute, Portland, OR, USA
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Carrabotta M, Laginestra MA, Durante G, Mancarella C, Landuzzi L, Parra A, Ruzzi F, Toracchio L, De Feo A, Giusti V, Pasello M, Righi A, Lollini PL, Palmerini E, Donati DM, Manara MC, Scotlandi K. Integrated Molecular Characterization of Patient-Derived Models Reveals Therapeutic Strategies for Treating CIC-DUX4 Sarcoma. Cancer Res 2022; 82:708-720. [PMID: 34903601 PMCID: PMC9359717 DOI: 10.1158/0008-5472.can-21-1222] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/18/2021] [Accepted: 11/30/2021] [Indexed: 01/07/2023]
Abstract
Capicua-double homeobox 4 (CIC-DUX4)-rearranged sarcomas (CDS) are extremely rare, highly aggressive primary sarcomas that represent a major therapeutic challenge. Patients are treated according to Ewing sarcoma protocols, but CDS-specific therapies are strongly needed. In this study, RNA sequencing was performed on patient samples to identify a selective signature that differentiates CDS from Ewing sarcoma and other fusion-driven sarcomas. This signature was used to validate the representativeness of newly generated CDS experimental models-patient-derived xenografts (PDX) and PDX-derived cell lines-and to identify specific therapeutic vulnerabilities. Annotation analysis of differentially expressed genes and molecular gene validation highlighted an HMGA2/IGF2BP/IGF2/IGF1R/AKT/mTOR axis that characterizes CDS and renders the tumors particularly sensitive to combined treatments with trabectedin and PI3K/mTOR inhibitors. Trabectedin inhibited IGF2BP/IGF2/IGF1R activity, but dual inhibition of the PI3K and mTOR pathways was required to completely dampen downstream signaling mediators. Proof-of-principle efficacy for the combination of the dual AKT/mTOR inhibitor NVP-BEZ235 (dactolisib) with trabectedin was obtained in vitro and in vivo using CDS PDX-derived cell lines, demonstrating a strong inhibition of local tumor growth and multiorgan metastasis. Overall, the development of representative experimental models (PDXs and PDX-derived cell lines) has helped to identify the unique sensitivity of the CDS to AKT/mTOR inhibitors and trabectedin, revealing a mechanism-based therapeutic strategy to fight this lethal cancer. SIGNIFICANCE This study identifies altered HMGA2/IGF2BP/IGF2 signaling in CIC-DUX4 sarcomas and provides proof of principle for combination therapy with trabectedin and AKT/mTOR dual inhibitors to specifically combat the disease.
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Affiliation(s)
- Marianna Carrabotta
- Experimental Oncology Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Giorgio Durante
- Experimental Oncology Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Caterina Mancarella
- Experimental Oncology Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Lorena Landuzzi
- Experimental Oncology Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alessandro Parra
- Experimental Oncology Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Francesca Ruzzi
- Laboratory of Immunology and Biology of Metastasis, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Lisa Toracchio
- Experimental Oncology Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alessandra De Feo
- Experimental Oncology Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Veronica Giusti
- Experimental Oncology Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Michela Pasello
- Experimental Oncology Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Righi
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Pier-Luigi Lollini
- Laboratory of Immunology and Biology of Metastasis, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Emanuela Palmerini
- Osteoncology, Bone and Soft Tissue Sarcoma and Novel Therapy Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Davide Maria Donati
- Third Orthopaedic Clinic and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | | | - Katia Scotlandi
- Experimental Oncology Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Kiesel BF, Guo J, Parise RA, Venkataramanan R, Clump DA, Bakkenist CJ, Beumer JH. Dose-dependent bioavailability and tissue distribution of the ATR inhibitor AZD6738 (ceralasertib) in mice. Cancer Chemother Pharmacol 2022; 89:231-242. [PMID: 35066692 PMCID: PMC8829872 DOI: 10.1007/s00280-021-04388-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/14/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE Ataxia telangiectasia and Rad3-related (ATR) initiates and regulates cellular responses to DNA damage, such as those caused by cancer treatments. Several ATR inhibitors (ATRi) are in clinical development including AZD6738. Therapeutic indices among ATRi may differ as a result of varying potencies and concentrations at both tumor and off-target sites. Additionally, AZD6738 contributes to anti-tumor immune responses necessitating evaluation of exposure at immunological sites. METHODS Using mouse models and a highly sensitive LC-MS/MS assay, the pharmacokinetics of AZD6738 were studied, including dose linearity, bioavailability, metabolism, and tissue distribution in tumor-bearing mice. RESULTS Initial studies identified dose-dependent bioavailability, with greater than proportional increases in exposure as dose increased resulting in a ~ twofold increase in bioavailability between the lowest and highest investigated doses. These behaviors were successfully captured with a compartmental PK model. Analysis of metabolite PK revealed decreasing metabolic ratios with increasing dose, indicative of saturable first-pass metabolism. Further analysis revealed that intestinal and gut metabolism contribute to metabolism and these saturable mechanisms. Studies of tumor and tissue distribution found rapid and extensive drug distribution to most tissues except brain and spinal cord. CONCLUSION The complex non-linear behavior of AZD6738 PK in mice was due to pre-systemic saturation and which appears to be recapitulated clinically at low doses. PK reported here will allow future correlation of tissue related toxicities with drug exposure as well as exposure with immunological responses. These results can also be compared with those from similar studies of other ATRi to contrast drug exposure with responses.
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Affiliation(s)
- Brian F Kiesel
- Cancer Therapeutics Drug Discovery Program, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jianxia Guo
- Cancer Therapeutics Drug Discovery Program, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - Robert A Parise
- Cancer Therapeutics Drug Discovery Program, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - Raman Venkataramanan
- Cancer Therapeutics Drug Discovery Program, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
- Department of Pathology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - David A Clump
- Department of Radiation Oncology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Christopher J Bakkenist
- Department of Radiation Oncology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Pharmacology and Chemical Biology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jan H Beumer
- Cancer Therapeutics Drug Discovery Program, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA.
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA.
- Division of Hematology-Oncology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- UPMC Hillman Cancer Center, Room G27e, 5117 Centre Ave, Pittsburgh, PA, 15213, USA.
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Kamachi K, Ureshino H, Watanabe T, Yoshida N, Yamamoto Y, Kurahashi Y, Fukuda-Kurahashi Y, Hayashi Y, Hirai H, Yamashita S, Ushijima T, Okada S, Kimura S. Targeting DNMT1 by demethylating agent OR-2100 increases tyrosine kinase inhibitors-sensitivity and depletes leukemic stem cells in chronic myeloid leukemia. Cancer Lett 2022; 526:273-283. [PMID: 34875342 DOI: 10.1016/j.canlet.2021.11.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/28/2021] [Accepted: 11/30/2021] [Indexed: 12/20/2022]
Abstract
ABL1 tyrosine kinase inhibitors (TKIs) dramatically improve the prognosis of chronic myeloid leukemia (CML), but 10-20% of patients achieve suboptimal responses with low TKIs sensitivity. Furthermore, residual leukemic stem cells (LSCs) are involved in the molecular relapse after TKIs discontinuation. Aberrant DNA hypermethylation contributes to low TKIs sensitivity and the persistence of LSCs in CML. DNMT1 is a key regulator of hematopoietic stem cells, suggesting that aberrant DNA hypermethylation targeting DNMT1 represents a potential therapeutic target for CML. We investigated the efficacy of OR-2100 (OR21), the first orally available single-compound prodrug of decitabine. OR21 exhibited anti-tumor effects as a monotherapy, and in combination therapy it increased TKI-induced apoptosis and induction of tumor suppressor genes including PTPN6 encoding SHP-1 in CML cells. OR21 in combination with imatinib significantly suppressed tumor growth in a xenotransplant model. OR21 and combination therapy decreased the abundance of LSCs and inhibited engraftment in a BCR-ABL1-transduced mouse model. These results demonstrate that targeting DNMT1 using OR21 exerts anti-tumor effects and impairs LSCs in CML. Therefore, combination treatment of TKIs and OR21 represents a promising treatment strategy in CML.
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Affiliation(s)
- Kazuharu Kamachi
- Department of Drug Discovery and Biomedical Sciences, Faculty of Medicine, Saga University, Saga, Japan; Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Hiroshi Ureshino
- Department of Drug Discovery and Biomedical Sciences, Faculty of Medicine, Saga University, Saga, Japan; Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan.
| | - Tatsuro Watanabe
- Department of Drug Discovery and Biomedical Sciences, Faculty of Medicine, Saga University, Saga, Japan
| | - Nao Yoshida
- Department of Drug Discovery and Biomedical Sciences, Faculty of Medicine, Saga University, Saga, Japan
| | - Yuta Yamamoto
- Department of Drug Discovery and Biomedical Sciences, Faculty of Medicine, Saga University, Saga, Japan
| | - Yuki Kurahashi
- Department of Drug Discovery and Biomedical Sciences, Faculty of Medicine, Saga University, Saga, Japan; OHARA Pharmaceutical Co., Ltd, Japan
| | - Yuki Fukuda-Kurahashi
- Department of Drug Discovery and Biomedical Sciences, Faculty of Medicine, Saga University, Saga, Japan; OHARA Pharmaceutical Co., Ltd, Japan
| | - Yoshihiro Hayashi
- Laboratory of Oncology, School of Life Sciences, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Hideyo Hirai
- Laboratory of Stem Cell Regulation, School of Life Sciences, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Satoshi Yamashita
- Division of Epigenomics, National Cancer Center Research Institute, Tokyo, Japan
| | - Toshikazu Ushijima
- Division of Epigenomics, National Cancer Center Research Institute, Tokyo, Japan
| | - Seiji Okada
- Division of Hematopoiesis, Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan
| | - Shinya Kimura
- Department of Drug Discovery and Biomedical Sciences, Faculty of Medicine, Saga University, Saga, Japan; Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
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44
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Rodia R, Pani F, Caocci G, La Nasa G, Simula MP, Mulas O, Velluzzi F, Loviselli A, Mariotti S, Boi F. Thyroid autoimmunity and hypothyroidism are associated with deep molecular response in patients with chronic myeloid leukemia on tyrosine kinase inhibitors. J Endocrinol Invest 2022; 45:291-300. [PMID: 34283388 PMCID: PMC8783879 DOI: 10.1007/s40618-021-01613-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/13/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Thyroid alterations including de novo appearance of thyroid autoimmunity are adverse effects of tyrosine kinase inhibitors, used in solid and hematologic cancer therapy, but the relationship between thyroid alterations during this treatment and the outcome of chronic myeloid leukemia remains unclear. Aim of this study was to investigate whether the presence of thyroid alterations may affect the clinical outcome of chronic myeloid leukemia on tyrosine kinase inhibitors. METHODS We evaluated thyroid function and autoimmunity in 69 chronic myeloid leukemia patients on long-term therapy looking at the association between thyroid abnormalities and disease molecular response. RESULTS Overall, 24 of 69 (34.8%) had one or more thyroid abnormalities during therapy. A high percentage of patients (21/69, 30.4%) showed thyroid autoimmunity (positive thyroid autoantibodies with ultrasound hypoechogenicity), while clinical and subclinical hypothyroidism and subclinical hyperthyroidism were, respectively, found in 4 of 69 (5.8%) and 3 of 69 (4.3%) of cases. Second-generation tyrosine kinase inhibitors resulted significantly associated (14/32, 43.7%) with Hashimoto's thyroiditis, compared to first generation (7/37, 18.9%; p = 0.03). Interestingly, we also found a significant association between euthyroid (14/26, 53.8%) and hypothyroid Hashimoto's thyroiditis (4/26, 15.4%) in patients with deep molecular response, as compared to euthyroid (3/43, 7%; p = 0.0001) and hypothyroid (0/43, 0%; p = 0.02) Hashimoto's thyroiditis patients with major molecular response. CONCLUSIONS Our study confirms and extends our knowledge on the tyrosine kinase inhibitors effects on thyroid, showing that thyroid autoimmunity is frequently observed in chronic myeloid leukemia patients on long-term therapy and is associated with a better oncological response.
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Affiliation(s)
- R Rodia
- Endocrinology Unit, Department of Medical Sciences and Public Health, University of Cagliari, Azienda Ospedaliero-Universitaria di Cagliari, SS 554, Bivio per Sestu, Monserrato, 09042, Cagliari, Italy
| | - F Pani
- Division of Immunology, Department of Pathology, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - G Caocci
- Ematology and CTMO, Businco Hospital, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - G La Nasa
- Ematology and CTMO, Businco Hospital, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - M P Simula
- Ematology and CTMO, Businco Hospital, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - O Mulas
- Ematology and CTMO, Businco Hospital, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - F Velluzzi
- Endocrinology Unit, Department of Medical Sciences and Public Health, University of Cagliari, Azienda Ospedaliero-Universitaria di Cagliari, SS 554, Bivio per Sestu, Monserrato, 09042, Cagliari, Italy
| | - A Loviselli
- Endocrinology Unit, Department of Medical Sciences and Public Health, University of Cagliari, Azienda Ospedaliero-Universitaria di Cagliari, SS 554, Bivio per Sestu, Monserrato, 09042, Cagliari, Italy
| | - S Mariotti
- Endocrinology Unit, Department of Medical Sciences and Public Health, University of Cagliari, Azienda Ospedaliero-Universitaria di Cagliari, SS 554, Bivio per Sestu, Monserrato, 09042, Cagliari, Italy
| | - F Boi
- Endocrinology Unit, Department of Medical Sciences and Public Health, University of Cagliari, Azienda Ospedaliero-Universitaria di Cagliari, SS 554, Bivio per Sestu, Monserrato, 09042, Cagliari, Italy.
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45
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Su R, Zhu J, Wu S, Luo H, He Y. Prognostic Significance of Platelet (PLT) and Platelet to Mean Platelet Volume (PLT/MPV) Ratio During Apatinib Second-Line or Late-Line Treatment in Advanced Esophageal Squamous Cell Carcinoma Patients. Technol Cancer Res Treat 2022; 21:15330338211072974. [PMID: 35072577 PMCID: PMC8808027 DOI: 10.1177/15330338211072974] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Apatinib has a certain efficacy for advanced esophageal squamous cell carcinoma (ESCC). This study aimed to investigate the prognostic significance of platelet (PLT) and platelet to mean platelet volume (PLT/MPV) ratio for advanced ESCC patients with apatinib second-line or late-line treatment. Methods: A retrospective study included 80 patients with advanced ESCC who received Apatinib ≥ 2 lines targeted therapy. We collected baseline clinical characteristics and blood parameters from the patients. Kaplan-Meier plots and univariate and multivariate analysis were used to find the factors related to progression-free survival (PFS). Results: The optimal cut-off values of PLT and PLT/MPV ratio were determined by X-tile software. Kaplan-Meier analysis demonstrated that patients in the high PLT group had better PFS than those in the low PLT group (156 d vs 80 d, P <.001), and patients in the high PLT/MPV ratio group had better PFS than those in low PLT/MPV ratio group (157 d vs 85 d, P <.001). Univariate analysis revealed pretreatment PLT and PLT/MPV ratio were significantly correlated with PFS. Multivariate analysis revealed high levels of pretreatment PLT/MPV ratio was an independent predictor of longer PFS (HR: 0.257, 95% CI: 0.089-0.743, P = .012). Conclusion: High levels of baseline PLT and PLT/MPV may indicate a better prognosis in apatinib ≥ 2 lines treatment for advanced ESCC patients.
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Affiliation(s)
- Rixin Su
- Anhui Provincial Hospital Affiliated to Anhui Medical University,
Luyang District, Hefei, China
| | - Jingya Zhu
- Anhui Provincial Hospital Affiliated to Anhui Medical University,
Luyang District, Hefei, China
| | - Shusheng Wu
- West Branch of the First Affiliated Hospital of University of
Science and Technology of China, Shushan District, Hefei, China Rixin Su and Jingya
Zhu contributed equally to this work and should be considered co-first
authors
| | - Huiqin Luo
- West Branch of the First Affiliated Hospital of University of
Science and Technology of China, Shushan District, Hefei, China Rixin Su and Jingya
Zhu contributed equally to this work and should be considered co-first
authors
| | - Yifu He
- West Branch of the First Affiliated Hospital of University of
Science and Technology of China, Shushan District, Hefei, China Rixin Su and Jingya
Zhu contributed equally to this work and should be considered co-first
authors
- Yifu He, West Branch of the First
Affiliated Hospital of University of Science and Technology of China, No. 107
Huanhudong Road, Shushan District, Hefei, China.
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46
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Dosne AG, Valade E, Goeyvaerts N, De Porre P, Avadhani A, O'Hagan A, Li LY, Ouellet D, Perez Ruixo JJ. Exposure-response analyses of erdafitinib in patients with locally advanced or metastatic urothelial carcinoma. Cancer Chemother Pharmacol 2022; 89:151-164. [PMID: 34977972 PMCID: PMC8807442 DOI: 10.1007/s00280-021-04381-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 11/22/2021] [Indexed: 11/26/2022]
Abstract
Background Exposure–response analyses were conducted to explore the relationship between selected efficacy and safety endpoints and serum phosphate (PO4) concentrations, a potential biomarker of efficacy and safety, in locally advanced or metastatic urothelial carcinoma patients with FGFR alterations treated with erdafitinib. Methods Data from two dosing regimens of erdafitinib in a phase 2 study (NCT02365597), 6 and 8-mg/day with provision for pharmacodynamically guided titration per serum PO4 levels, were analyzed using Cox proportional hazard or logistic regression models. Efficacy endpoints were overall survival (OS), progression-free survival (PFS), and objective response rate (ORR). Safety endpoints were adverse events typical for FGFR inhibitors. Results Exposure-efficacy analyses on 156 patients (6-mg = 68; 8-mg = 88) showed that patients with higher serum PO4 levels within the first 6 weeks showed better OS (hazard ratio 0.57 [95% CI 0.46–0.72] per mg/dL of PO4; p = 0.01), PFS (hazard ratio 0.80 [0.67–0.94] per mg/dL of PO4; p = 0.01), and ORR (odds ratio 1.38 [1.02–1.86] per mg/dL of PO4; p = 0.04). Exposure-safety analyses on 177 patients (6-mg = 78; 8-mg = 99) showed that the incidence of selected adverse events associated with on-target off-tumor effects significantly rose with higher PO4. Conclusions The exploratory relationship between serum PO4 levels and efficacy/safety outcomes supported the use of pharmacodynamically guided dose titration to optimize erdafitinib’s therapeutic benefit/risk ratio. Clinical trial registration number NCT02365597. Supplementary Information The online version contains supplementary material available at 10.1007/s00280-021-04381-4.
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Affiliation(s)
| | | | | | | | | | - Anne O'Hagan
- Janssen Research and Development, Spring House, PA, USA
| | - Lilian Y Li
- Janssen Research and Development, Spring House, PA, USA
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Chen Z, Vallega KA, Chen H, Zhou J, Ramalingam SS, Sun SY. The natural product berberine synergizes with osimertinib preferentially against MET-amplified osimertinib-resistant lung cancer via direct MET inhibition. Pharmacol Res 2022; 175:105998. [PMID: 34826601 PMCID: PMC8755628 DOI: 10.1016/j.phrs.2021.105998] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/04/2021] [Accepted: 11/21/2021] [Indexed: 01/03/2023]
Abstract
Berberine is a natural product that has long been used in traditional Chinese medicine due to its antimicrobial, anti-inflammatory and metabolism-regulatory properties. Osimertinib is the first third-generation EGFR-tyrosine kinase inhibitor (TKI) approved for the treatment of non-small cell lung cancer (NSCLC) with activating EGFR mutations and those resistant to earlier generation EGFR-TKIs due to a T790M mutation. However, emergence of acquired resistance to osimertinib limits its long-term efficacy in the clinic. One known mechanism of acquired resistance to osimertinib and other EGFR-TKIs is MET (c-MET) gene amplification. Here, we report that berberine, when combined with osimertinib, synergistically and selectively decreased the survival of several MET-amplified osimertinib-resistant EGFR mutant NSCLC cell lines with enhanced induction of apoptosis likely through Bim elevation and Mcl-1 reduction. Importantly, this combination effectively enhanced suppressive effect on the growth of MET-amplified osimertinib-resistant xenografts in nude mice and was well tolerated. Molecular modeling showed that berberine was able to bind to the kinase domain of non-phosphorylated MET, occupy the front of the binding pocket, and interact with the activation loop, in a similar way as other known MET inhibitors do. MET kinase assay showed clear concentration-dependent inhibitory effects of berberine against MET activity, confirming its kinase inhibitory activity. These findings collectively suggest that berberine can act as a naturally-existing MET inhibitor to synergize with osimertinib in overcoming osimertinib acquired resistance caused by MET amplification.
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Affiliation(s)
- Zhen Chen
- Department of Hematology and Medical Oncology, Emory University School of Medicine and Winship Cancer Institute, Atlanta, GA, USA
| | - Karin A Vallega
- Department of Hematology and Medical Oncology, Emory University School of Medicine and Winship Cancer Institute, Atlanta, GA, USA
| | - Haiying Chen
- Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Jia Zhou
- Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Suresh S Ramalingam
- Department of Hematology and Medical Oncology, Emory University School of Medicine and Winship Cancer Institute, Atlanta, GA, USA
| | - Shi-Yong Sun
- Department of Hematology and Medical Oncology, Emory University School of Medicine and Winship Cancer Institute, Atlanta, GA, USA.
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48
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Lee C, Kim M, Kim DW, Kim TM, Kim S, Im SW, Jeon YK, Keam B, Ku JL, Heo DS. Acquired Resistance Mechanism of EGFR Kinase Domain Duplication to EGFR TKIs in Non-Small Cell Lung Cancer. Cancer Res Treat 2022; 54:140-149. [PMID: 33940786 PMCID: PMC8756122 DOI: 10.4143/crt.2021.385] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 04/30/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Epidermal growth factor receptor kinase domain duplication (EGFR-KDD) is a rare and poorly understood oncogenic mutation in non-small cell lung cancer (NSCLC). We aimed to investigate the acquired resistance mechanism of EGFR-KDD against EGFR-TKIs. MATERIALS AND METHODS We identified EGFR-KDD in tumor tissue obtained from a patient with stage IV lung adenocarcinoma and established the patient-derived cell line SNU-4784. We also established several EGFR-KDD Ba/F3 cell lines: EGFR-KDD wild type (EGFR-KDDWT), EGFR-KDD domain 1 T790M (EGFR-KDDD1T), EGFR-KDD domain 2 T790M (EGFR-KDDD2T), and EGFR-KDD both domain T790M (EGFR-KDDBDT). We treated the cells with EGFR tyrosine kinase inhibitors (TKIs) and performed cell viability assays, immunoblot assays, and ENU (N-ethyl-N-nitrosourea) mutagenesis screening. RESULTS In cell viability assays, SNU-4784 cells and EGFR-KDDWT Ba/F3 cells were sensitive to 2nd generation and 3rd generation EGFR TKIs. In contrast, the T790M-positive EGFR-KDD Ba/F3 cell lines (EGFR-KDDT790M) were only sensitive to 3rd generation EGFR TKIs. In ENU mutagenesis screening, we identified the C797S mutation in kinase domain 2 of EGFR-KDDBDT Ba/F3 cells. Based on this finding, we established an EGFR-KDD domain 1 T790M/domain 2 cis-T790M+C797S (EGFR-KDDT/T+C) Ba/F3 model, which was resistant to EGFR TKIs and anti-EGFR monoclonal antibody combined with EGFR TKIs. CONCLUSION Our study reveals that the T790M mutation in EGFR-KDD confers resistance to 1st and 2nd generation EGFR TKIs, but is sensitive to 3rd generation EGFR TKIs. In addition, we identified that the C797S mutation in kinase domain 2 of EGFR-KDDT790M mediates a resistance mechanism against 3rd generation EGFR TKIs.
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Affiliation(s)
- Chaelin Lee
- Cancer Research Institute, Seoul National University, Seoul,
Korea
| | - Miso Kim
- Cancer Research Institute, Seoul National University, Seoul,
Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
| | - Dong-Wan Kim
- Cancer Research Institute, Seoul National University, Seoul,
Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
- Integrated Major in Innovative Medical Science, Seoul National University College of Medicine, Seoul,
Korea
| | - Tae Min Kim
- Cancer Research Institute, Seoul National University, Seoul,
Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
| | - Soyeon Kim
- Cancer Research Institute, Seoul National University, Seoul,
Korea
- Integrated Major in Innovative Medical Science, Seoul National University College of Medicine, Seoul,
Korea
| | - Sun-Wha Im
- Genomic Medicine Institute, Medical Research Center, Seoul National University, Seoul,
Korea
| | - Yoon Kyung Jeon
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
| | - Bhumsuk Keam
- Cancer Research Institute, Seoul National University, Seoul,
Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
| | - Ja-Lok Ku
- Cancer Research Institute, Seoul National University, Seoul,
Korea
| | - Dae Seog Heo
- Cancer Research Institute, Seoul National University, Seoul,
Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
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49
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Zhou X, Jin T, Wang L, Zhao E, Xiao X. Clinical practice of epidermal growth factor receptor-tyrosine kinase inhibitor targeted drugs combined with gadolinium oxide nanoparticles in the treatment of non-small cell lung cancer. Bioengineered 2022; 13:128-139. [PMID: 34818973 PMCID: PMC8805885 DOI: 10.1080/21655979.2021.2009969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/18/2021] [Indexed: 12/25/2022] Open
Abstract
It was to explore the clinical efficacy and safety of epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) targeted drugs combined with hyaluronic acid-gadolinium sesquioxide-nanoparticles (HA-Gd2O3-NPs) in non-small cell lung cancer (NSCLC). In this study, 70 patients with stage IV EGFR mutant NSCLC diagnosed in the First Affiliated Hospital of Jinzhou Medical University were selected. They were randomly divided into the combined group (35 cases) and the control group (35 cases). HA-Gd2O3-NPs were prepared by hydrothermal polymerization, and combined with EGFR-TKI in the clinical treatment of NSCLC. The results showed that HA-Gd2O3-NPs were spherical with a uniform particle size of about 124 nm. The NSCLC survival rate of the combined group was 37.2 ± 5.3% under 6 Gy X-ray irradiation, and that of the control group was 98.4 ± 12.6% under 6 Gy X-ray irradiation. The total effective rate of the control group (20%) was significantly lower than that of the study group (42.86%) (P < 0.05). The one-year survival rate of the combined group (94%) was significantly higher than that of the control group (75%) (P < 0.05). The median progression-free survival (PFS) in the control group was 8 months, and that in the combined group was 12 months, with statistical difference (P < 0.05). EGFR-TKI targeted drugs combined with HA-Gd2O3-NPs can significantly improve the clinical efficacy of stage IV EGFR mutant NSCLC patients and benefit their survival.
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Affiliation(s)
- Xuan Zhou
- Department of Thoracic Surgery, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Ting Jin
- Department of Rehabilitation, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Likun Wang
- Department of Thoracic Surgery, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Erlin Zhao
- Department of Thoracic Surgery, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Xuyang Xiao
- Department of Thoracic Surgery, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
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50
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Abstract
Cabozantinib (Cabometyx) is now approved to treat locally advanced or metastatic differentiated thyroid cancer that has progressed following prior vascular endothelial growth factor receptor-targeted therapy.
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Affiliation(s)
- Diane S Aschenbrenner
- Diane S. Aschenbrenner is a former member of the faculty at Notre Dame of Maryland University and the Johns Hopkins University School of Nursing. She coordinates Drug Watch :
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